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General NPI Number Information
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NPI Number | 1700110921
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Entity Type | Individual
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Provider Name | STEPHEN EDWARD SLATTERY D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/21/2009
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Last Update Date | 12/30/2016
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Provider Practice Location Address
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Address Line | 17055 RUBEN LN
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City | SANDY
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State | OR
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Zip | 97055-9276
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Country | US
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Telephone | 503-668-8002
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Fax | 503-668-5246
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Provider Business Mailing Address
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Address Line | 10000 SE MAIN ST SUITE 116
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City | PORTLAND
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State | OR
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Zip | 97216-2448
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Country | US
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Telephone | 503-251-6292
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A11657
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO126175
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License Number State | OR
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