Individual
MR. PAUL DENNIS WACEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
875 OAK ST SE, SUITE 5020, SALEM, OR 97301-3975
(503) 371-4044
(503) 371-4356
Mailing address
847 NE 19TH AVE, SUITE 300, PORTLAND, OR 97232-2684
(503) 963-2801
(503) 963-2825
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01087
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500605090
—
OR
Enumeration date
06/26/2006
Last updated
06/18/2015
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