Healthcare Provider Details

I. General information

NPI: 1407964968
Provider Name (Legal Business Name): MARK STEVEN KESTNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N GRAHAM ST SUITE 580
PORTLAND OR
97227-1654
US

IV. Provider business mailing address

2801 N GANTENBEIN AVE
PORTLAND OR
97227-1623
US

V. Phone/Fax

Practice location:
  • Phone: 503-528-0704
  • Fax: 503-528-0708
Mailing address:
  • Phone: 503-413-4647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD23365
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD23365
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD23365
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: