Provider Demographics
NPI:1447201215
Name:WEIL, STEPHEN ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ALAN
Last Name:WEIL
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 1:4035 SW MERCANTILE DR
Mailing Address - Street 2:STE 101
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035
Mailing Address - Country:US
Mailing Address - Phone:503-697-3001
Mailing Address - Fax:503-697-0906
Practice Address - Street 1:4035 SW MERCANTILE DR
Practice Address - Street 2:STE 101
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035
Practice Address - Country:US
Practice Address - Phone:503-697-3001
Practice Address - Fax:503-697-0906
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD07794207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR238535Medicaid
OR238535Medicaid
C94554Medicare UPIN