Provider Demographics
NPI:1558341099
Name:MANN, STEPHEN A (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:A
Last Name:MANN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-0670
Mailing Address - Country:US
Mailing Address - Phone:541-389-7741
Mailing Address - Fax:541-388-3832
Practice Address - Street 1:929 SW SIMPSON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3599
Practice Address - Country:US
Practice Address - Phone:541-389-7741
Practice Address - Fax:541-278-8376
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD012467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR188854Medicaid
OR188854Medicaid
OR188854Medicaid