Healthcare Provider Details

I. General information

NPI: 1992729420
Provider Name (Legal Business Name): PAUL J DUWELIUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11782 SW BARNES RD STE 300
PORTLAND OR
97225-5914
US

IV. Provider business mailing address

11782 SW BARNES RD STE 300
PORTLAND OR
97225-5914
US

V. Phone/Fax

Practice location:
  • Phone: 503-214-5200
  • Fax: 503-906-6613
Mailing address:
  • Phone: 503-214-5200
  • Fax: 503-906-6613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number15812
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD15812
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberMD15812
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD15812
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: