Provider Demographics
NPI:1356548861
Name:MANSBERGER, STEVEN L (MD, MPH)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:MANSBERGER
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 NW 22ND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3057
Mailing Address - Country:US
Mailing Address - Phone:503-413-8202
Mailing Address - Fax:503-413-6937
Practice Address - Street 1:1040 NW 22ND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3057
Practice Address - Country:US
Practice Address - Phone:503-413-8202
Practice Address - Fax:503-413-6937
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22167207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130347Medicaid
ORH09653Medicare UPIN
OR106220Medicare ID - Type UnspecifiedGACPC MEDICARE NUMBER