Provider Demographics
NPI:1558393876
Name:RUESCH, PAUL D (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:RUESCH
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 1:6542 SE LAKE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2237
Mailing Address - Country:US
Mailing Address - Phone:503-659-1769
Mailing Address - Fax:503-659-7522
Practice Address - Street 1:6542 SE LAKE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-2237
Practice Address - Country:US
Practice Address - Phone:503-659-1769
Practice Address - Fax:503-659-7522
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24463207X00000X
ORMD24663207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR119565Medicare PIN
ORG40515Medicare UPIN