Healthcare Provider Details

I. General information

NPI: 1730181199
Provider Name (Legal Business Name): DAVID ANDREW STANECK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12205 SW TUALATIN RD STE 100
TUALATIN OR
97062-7663
US

IV. Provider business mailing address

12205 SW TUALATIN RD STE 100
TUALATIN OR
97062-7663
US

V. Phone/Fax

Practice location:
  • Phone: 503-223-6223
  • Fax: 503-223-3665
Mailing address:
  • Phone: 503-223-6223
  • Fax: 503-223-3665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number169792
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: