Provider Demographics
NPI:1649256892
Name:TERSIGNI, STEVEN ALAN (MD, FACS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ALAN
Last Name:TERSIGNI
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-0000
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:541-266-4502
Practice Address - Street 1:1900 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-0000
Practice Address - Country:US
Practice Address - Phone:541-267-5151
Practice Address - Fax:541-266-4502
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19395208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORCD8723OtherRR MEDICARE GROUP NUMBER
OR020041945OtherRR MEDICARE PTAN NUMBER
OR073635Medicaid
OR1407812365OtherNBMC GROUP NPI NUMBER
ORR0000WFBTVOtherMEDICARE GROUP PIN NUMBER
OR930635514OtherGROUP TAX ID NUMBER
OR930635514OtherGROUP TAX ID NUMBER
OR1407812365OtherNBMC GROUP NPI NUMBER
ORR111717Medicare PIN