Provider Demographics
NPI:1760821664
Name:BISCARO, GELAR PAUL NOCON (DO)
Entity Type:Individual
Prefix:
First Name:GELAR PAUL
Middle Name:NOCON
Last Name:BISCARO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:GELAR
Other - Middle Name:PAUL
Other - Last Name:BISCARO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4399
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4399
Mailing Address - Country:US
Mailing Address - Phone:503-413-3900
Mailing Address - Fax:503-413-3710
Practice Address - Street 1:475 S COLUMBIA RIVER HWY STE 100
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-2860
Practice Address - Country:US
Practice Address - Phone:503-397-0471
Practice Address - Fax:503-366-3014
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOL60386631207Q00000X
WAOP60683758207Q00000X
ORDO195946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1760821664Medicaid
WA2039121OtherMEDICAID PROVIDER ONE ID