MEDICARE: JESSE MARTIN PAPAC MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD125796	OR

General Provider Information

NPI Number	:	1316156540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE MARTIN PAPAC MD

Provider Business Mailing Address
First Line	:	849 PACIFIC AVE
Second Line	:
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-1956
Country	:	US
Telephone Number	:	541-296-4238
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 E 7TH ST
Second Line	:
City	:	THE DALLES
State	:	OR
Zip	:	97058-2607
Country	:	US
Telephone Number	:	541-386-6380
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	10/23/2009

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