Healthcare Provider Details

I. General information

NPI: 1639152549
Provider Name (Legal Business Name): JAMES H STAGEMAN III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 FAIRVIEW ST
SILVERTON OR
97381-1917
US

IV. Provider business mailing address

342 FAIRVIEW ST
SILVERTON OR
97381-1917
US

V. Phone/Fax

Practice location:
  • Phone: 503-873-1500
  • Fax: 503-873-1669
Mailing address:
  • Phone: 503-873-1500
  • Fax: 503-873-1669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD20608
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: