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General NPI Number Information
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NPI Number | 1417362104
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Entity Type | Individual
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Provider Name | BRIAN ALAN STEVENS D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2014
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Last Update Date | 07/23/2018
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Provider Practice Location Address
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Address Line | 10180 SE SUNNYSIDE RD
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City | CLACKAMAS
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State | OR
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Zip | 97015
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Country | US
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Telephone | 503-571-2880
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Fax |
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Provider Business Mailing Address
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Address Line | 7936 N WAYLAND AVE
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City | PORTLAND
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State | OR
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Zip | 97203-5802
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Country | US
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Telephone | 813-732-9580
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 5101021377
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | DO186776
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License Number State | OR
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