Provider Demographics
NPI:1760599351
Name:DESSIEUX, GUESLY (DO)
Entity Type:Individual
Prefix:
First Name:GUESLY
Middle Name:
Last Name:DESSIEUX
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 1:1401 N 10TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-1486
Mailing Address - Country:US
Mailing Address - Phone:503-769-6386
Mailing Address - Fax:503-769-5647
Practice Address - Street 1:1401 N 10TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-1486
Practice Address - Country:US
Practice Address - Phone:503-769-6386
Practice Address - Fax:503-769-5647
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO27371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274478Medicaid
OROTH000Medicare UPIN
OR274478Medicaid