Healthcare Provider Details

I. General information

NPI: 1396665352
Provider Name (Legal Business Name): LUCAS STEFFL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 NW 22ND AVE STE 640
PORTLAND OR
97210-2993
US

IV. Provider business mailing address

1130 NW 22ND AVE STE 640
PORTLAND OR
97210-2993
US

V. Phone/Fax

Practice location:
  • Phone: 360-609-9816
  • Fax:
Mailing address:
  • Phone: 360-609-9816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1252963
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: