Provider Demographics
NPI:1891871455
Name:ESMER, GREGORY JOHN (DO)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:JOHN
Last Name:ESMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4039 N MISSISSIPPI AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1477
Mailing Address - Country:US
Mailing Address - Phone:503-970-2303
Mailing Address - Fax:503-719-7591
Practice Address - Street 1:4039 N MISSISSIPPI AVE STE 203
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1477
Practice Address - Country:US
Practice Address - Phone:503-970-2303
Practice Address - Fax:503-719-7591
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO26929204D00000X
ORD026929208D00000X
ME1826208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice