Individual
PAUL J DEITERING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9427 SW BARNES RD, SUITE 490, PORTLAND, OR 97225-6652
(503) 291-2123
(503) 292-1860
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
207RC0001X
Clinical Cardiac Electrophysiology Physician
PA00711
OR
363A00000X
Physician Assistant
Primary
PA00711
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
286755
—
OR
Enumeration date
06/20/2006
Last updated
03/09/2021
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