Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | MD 19613 | OR |
N | 207RI0200X | Infectious Disease | MD00025591 | WA |
NPI | 1083758130 |
---|---|
Provider Name | Paul Raymond Cieslak |
First Address | Portland, OR 97213-2439 |
Second Address | Portland, OR 97213-2439 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 21/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
232049 | (05) | OR |
H67774 | (02) |