Provider Demographics
NPI:1164581161
Name:RIFFENBURGH, STEPHEN KENT (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:KENT
Last Name:RIFFENBURGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 SE 164TH AVE
Mailing Address - Street 2:DEPT 358
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9324
Mailing Address - Country:US
Mailing Address - Phone:541-997-7401
Mailing Address - Fax:541-997-5975
Practice Address - Street 1:530 9TH STREET
Practice Address - Street 2:ORTHOPEDICS
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439
Practice Address - Country:US
Practice Address - Phone:541-997-7104
Practice Address - Fax:541-997-5975
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD156583207X00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA49873Medicare UPIN