Healthcare Provider Details

I. General information

NPI: 1356322499
Provider Name (Legal Business Name): STEPHEN G GIROLAMI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19250 SW 65TH AVE SUITE 300
TUALATIN OR
97062-7452
US

IV. Provider business mailing address

19250 SW 65TH AVE SUITE 300
TUALATIN OR
97062-7452
US

V. Phone/Fax

Practice location:
  • Phone: 503-692-1242
  • Fax: 503-691-3615
Mailing address:
  • Phone: 503-692-1242
  • Fax: 503-691-3615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD 17087
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: