Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | MD00034626 | WA |
Y | 204C00000X | Sports Medicine Doctor | OR MD13345 | OR |
NPI | 1134236292 |
---|---|
Provider Name | Dr. Stephen Joseph Ebner |
First Address | Milwaukie, OR 97267-6444 |
Second Address | Clackamas, OR 97015-8970 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 08/07/2007 |