Healthcare Provider Details

I. General information

NPI: 1558393876
Provider Name (Legal Business Name): PAUL D RUESCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10121 SE SUNNYSIDE RD STE 100
CLACKAMAS OR
97015-5755
US

IV. Provider business mailing address

10121 SE SUNNYSIDE RD STE 100
CLACKAMAS OR
97015-5755
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-1769
  • Fax: 503-659-7522
Mailing address:
  • Phone: 503-659-1769
  • Fax: 503-659-7522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD24463
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD24663
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: