Provider Demographics
NPI:1659361517
Name:STIGER, JOHN C (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:STIGER
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 1:15195 SE THORNTON DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-2551
Mailing Address - Country:US
Mailing Address - Phone:503-653-9767
Mailing Address - Fax:
Practice Address - Street 1:15195 SE THORNTON DR
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-2551
Practice Address - Country:US
Practice Address - Phone:503-653-9767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO09114207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR240523Medicaid
OR300793101OtherREGENCE BLUE CROSS
OR080144666OtherRAILROAD MEDICARE
OR332840204OtherCIGNA
OR4100832OtherAETNA INS
ORA003OtherTRICARE
OR4100832OtherAETNA INS
OR332840204OtherCIGNA