Basic Information
| Provider Information | |||||||||
| NPI: | 1467425629 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAHLS | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51377 SW OLD PORTLAND RD STE C | ||||||||
| Address2: | OHSU FAMILY MEDICINE AT SCAPPOOSE | ||||||||
| City: | SCAPPOOSE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970564023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034184222 | ||||||||
| FaxNumber: | 5034184223 | ||||||||
| Practice Location | |||||||||
| Address1: | 51377 SW OLD PORTLAND RD STE C | ||||||||
| Address2: | OHSU FAMILY MEDICINE AT SCAPPOOSE | ||||||||
| City: | SCAPPOOSE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970564023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034184222 | ||||||||
| FaxNumber: | 5034184223 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 11/21/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD13885 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 115741 | 05 | OR | MEDICAID | 00188007 | 01 | OR | IND BLUE CROSS | OTHER | J406418 | 01 | OR | IND PACSOURCE | OTHER | 080122426 | 01 | OR | IND RAILROAD | OTHER |