Provider Demographics
NPI:1861481913
Name:CANEPA, CLIFFORD STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:STEVEN
Last Name:CANEPA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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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 1:5050 NE HOYT ST
Practice Address - Street 2:SUITE 422
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2991
Practice Address - Country:US
Practice Address - Phone:503-488-2345
Practice Address - Fax:503-488-2350
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2013-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD13909208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR008735Medicaid
OR008735Medicaid
ORC92353Medicare UPIN
OR153149Medicare PIN