Provider Demographics
NPI:1609807973
Name:DEMEESTER, STEVEN RYAN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:RYAN
Last Name:DEMEESTER
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 1:847 NE 19TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2684
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:4805 NE GLISAN ST
Practice Address - Street 2:SUITE 6N60
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2933
Practice Address - Country:US
Practice Address - Phone:503-281-0561
Practice Address - Fax:503-416-7377
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG82268208600000X, 208G00000X
ORMD174787208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020039943OtherMEDICARE RAILROAD
WA2049670Medicaid
CA00G822680Medicaid
CA00G822680C29OtherCAL OPTIMA PIN
OR500696092Medicaid
CA00G822680OtherBLUE SHIELD PIN
CA00G822680C29OtherCAL OPTIMA PIN
CABM744ZMedicare PIN
CA00G822680Medicaid
WA2049670Medicaid
OR185328Medicare PIN