Provider Demographics
NPI:1679511562
Name:RESK, JAMES MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MATTHEW
Last Name:RESK
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 1:4161 NORFOLK ST
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-3742
Mailing Address - Country:US
Mailing Address - Phone:203-722-1325
Mailing Address - Fax:
Practice Address - Street 1:14279 GLEN OAK RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-8008
Practice Address - Country:US
Practice Address - Phone:503-657-1871
Practice Address - Fax:503-557-8651
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18335208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR057484Medicaid
OR057484Medicaid
ORF53603Medicare UPIN