Healthcare Provider Details

I. General information

NPI: 1891151221
Provider Name (Legal Business Name): GREGORY STEINKE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 3RD ST
TILLAMOOK OR
97141-3430
US

IV. Provider business mailing address

PO BOX 858
NEOTSU OR
97364-0858
US

V. Phone/Fax

Practice location:
  • Phone: 541-921-5195
  • Fax: 971-264-2686
Mailing address:
  • Phone: 541-921-5195
  • Fax: 971-264-2686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD151015
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD151015
License Number StateOR

VIII. Authorized Official

Name: DR. GREGORY LLOYD STEINKE
Title or Position: OWNER
Credential: M.D.
Phone: 541-921-5195