Provider Demographics
NPI:1902827827
Name:PAULISSEN, STEVEN JAMES (MD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:JAMES
Last Name:PAULISSEN
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 1:1234 COMMERCIAL ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4204
Mailing Address - Country:US
Mailing Address - Phone:503-362-9334
Mailing Address - Fax:503-362-8016
Practice Address - Street 1:1234 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4204
Practice Address - Country:US
Practice Address - Phone:503-362-9334
Practice Address - Fax:503-362-8016
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17094207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR021571OtherDMAP/OMAP
OR021571Medicaid
OR011WCQJJCMedicare ID - Type Unspecified
OR021571OtherDMAP/OMAP