Provider Demographics
NPI:1487647269
Name:CHAFFEE, STEPHEN JOHN (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JOHN
Last Name:CHAFFEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 SE MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-2634
Mailing Address - Country:US
Mailing Address - Phone:503-623-2345
Mailing Address - Fax:503-623-6071
Practice Address - Street 1:641 SE MILLER AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-2634
Practice Address - Country:US
Practice Address - Phone:503-623-2345
Practice Address - Fax:503-623-6071
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO18671207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR067582Medicaid
OR035329Medicare ID - Type Unspecified
OR067582Medicaid