Provider Demographics
NPI:1982800470
Name:TLUCEK, PAUL STANLEY (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:STANLEY
Last Name:TLUCEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2525 NW LOVEJOY ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2864
Mailing Address - Country:US
Mailing Address - Phone:503-274-2121
Mailing Address - Fax:
Practice Address - Street 1:2525 NW LOVEJOY ST STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2861
Practice Address - Country:US
Practice Address - Phone:503-274-2121
Practice Address - Fax:503-274-2947
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25649207R00000X
WA60335872207W00000X
IA39381207W00000X
OR161778207W00000X
WAMD60335872207WX0107X
ORMD161778207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology