MEDICARE: PAUL D. RUESCH, MD PC

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	MD24663	OR
2	207X00000X	Orthopaedic Surgery Physician	MD24663	OR

General Provider Information

NPI Number	:	1881818805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL D. RUESCH, MD PC

Provider Business Mailing Address
First Line	:	6542 SE LAKE RD
Second Line	:	SUITE 201
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-2244
Country	:	US
Telephone Number	:	503-659-1769
Fax Number	:	503-659-7522

Provider Business Practice Location Address
First Line	:	6542 SE LAKE RD
Second Line	:	SUITE 201
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-2244
Country	:	US
Telephone Number	:	503-659-1769
Fax Number	:	503-659-7522

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	PAUL D RUESCH
Credential	:	M.D.
Telephone Number	:	503-659-1769

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	05/14/2012

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