Healthcare Provider Details

I. General information

NPI: 1427086339
Provider Name (Legal Business Name): PAUL J. NEUMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N 10TH AVE STE 100
STAYTON OR
97383-1486
US

IV. Provider business mailing address

1401 N 10TH AVE STE 100
STAYTON OR
97383-1486
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-6386
  • Fax: 503-769-5647
Mailing address:
  • Phone: 503-769-6386
  • Fax: 503-769-5647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD24097
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: