Provider Demographics
NPI:1346315173
Name:TESAR, PAUL LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LOUIS
Last Name:TESAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 929
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-0929
Mailing Address - Country:US
Mailing Address - Phone:503-397-9038
Mailing Address - Fax:503-397-7115
Practice Address - Street 1:1870A SAINT HELENS ST
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-1747
Practice Address - Country:US
Practice Address - Phone:503-397-9038
Practice Address - Fax:503-397-7115
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD09962207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR159913Medicaid
OR159913Medicaid
OR0000BHPCKMedicare ID - Type Unspecified