MEDICARE: DR. STEPHEN B BADER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	MD17045	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790787422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN B BADER MD

Provider Business Mailing Address
First Line	:	541 NE 20TH AVE STE 225
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-2895
Country	:	US
Telephone Number	:	503-963-2801
Fax Number	:	503-963-2825

Provider Business Practice Location Address
First Line	:	4805 NE GLISAN ST
Second Line	:	GARDEN LEVEL
City	:	PORTLAND
State	:	OR
Zip	:	97213-2933
Country	:	US
Telephone Number	:	503-215-6029
Fax Number	:	503-215-6387

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	12/05/2023

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