Provider Demographics
NPI:1679586234
Name:FITCH, STEPHEN E (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:E
Last Name:FITCH
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:KAISER PERMANENTE SKYLINE MEDICAL OFFICE
Mailing Address - Street 2:5125 SKYLINE RD, S
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-9427
Mailing Address - Country:US
Mailing Address - Phone:503-588-5985
Mailing Address - Fax:503-588-5957
Practice Address - Street 1:SKYLINE MEDICAL OFFICE, 5125 SKYLINE RD, S
Practice Address - Street 2:KAISER PERMANENTE
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-9427
Practice Address - Country:US
Practice Address - Phone:503-588-5985
Practice Address - Fax:503-588-5957
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORDO224182085R0202X
NMA778-832085R0202X
OK26922085R0202X
AK27052085R0202X
CO341702085R0202X
WV14592085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology