Provider Demographics
NPI:1568454643
Name:FALZ, STEFANIE NONE (MD)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:NONE
Last Name:FALZ
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 1:1304 MONTELLO AVE
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1544
Mailing Address - Country:US
Mailing Address - Phone:541-386-3711
Mailing Address - Fax:541-386-6224
Practice Address - Street 1:1304 MONTELLO AVE
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1544
Practice Address - Country:US
Practice Address - Phone:541-386-3711
Practice Address - Fax:541-386-6224
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24963174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269739Medicaid
ORI30688Medicare UPIN
OR269739Medicaid