Provider Demographics
NPI:1437242963
Name:STEPHENS, SHEREE DIANE (MD)
Entity Type:Individual
Prefix:
First Name:SHEREE
Middle Name:DIANE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 NE STUCKI AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6945
Mailing Address - Country:US
Mailing Address - Phone:503-906-5100
Mailing Address - Fax:
Practice Address - Street 1:1925 NE STUCKI AVE STE 300
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97006-6945
Practice Address - Country:US
Practice Address - Phone:503-906-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23581207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORHO4688Medicare UPIN