Provider Demographics
NPI:1154633121
Name:PALUCK, MATHEW (DO)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:
Last Name:PALUCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 NE NEFF RD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4283
Mailing Address - Country:US
Mailing Address - Phone:541-382-3344
Mailing Address - Fax:541-382-1681
Practice Address - Street 1:2200 NE NEFF RD
Practice Address - Street 2:SUITE #200
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4283
Practice Address - Country:US
Practice Address - Phone:541-382-3344
Practice Address - Fax:541-382-1681
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO172653208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR1808OtherTRAINING PERMIT