Provider Demographics
NPI:1346264074
Name:MACDONALD, STEVEN E (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:E
Last Name:MACDONALD
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 1:4361 SW BERTHA AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-1577
Mailing Address - Country:US
Mailing Address - Phone:503-729-8966
Mailing Address - Fax:
Practice Address - Street 1:4361 SW BERTHA AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-1577
Practice Address - Country:US
Practice Address - Phone:503-729-8966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14036207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1048834Medicaid
OR050035231OtherRR MEDICARE
MT1346264074Medicaid
AKMD036ORMedicaid
CAXPY197569Medicaid
OR026997Medicaid
MT1346264074Medicaid
CAXPY197569Medicaid