Provider Demographics
NPI:1538435417
Name:OGAWA, STEFANIE T (MD)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:T
Last Name:OGAWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:541-732-8370
Mailing Address - Fax:541-732-8371
Practice Address - Street 1:840 ROYAL AVE STE 110
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6461
Practice Address - Country:US
Practice Address - Phone:541-732-8370
Practice Address - Fax:541-732-8371
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD171511208000000X
CAA119727208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics