Healthcare Provider Details

I. General information

NPI: 1962696468
Provider Name (Legal Business Name): JOSEPH PAUL STEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39302 STRATFORD PL
SANDY OR
97055-5314
US

IV. Provider business mailing address

39302 STRATFORD PL
SANDY OR
97055-5314
US

V. Phone/Fax

Practice location:
  • Phone: 971-241-0232
  • Fax:
Mailing address:
  • Phone: 971-241-0232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: