Provider Demographics
NPI:1063589323
Name:DART, PAUL E (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:DART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3495 HARRIS STREET
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4248
Mailing Address - Country:US
Mailing Address - Phone:541-484-7202
Mailing Address - Fax:541-484-7415
Practice Address - Street 1:3495 HARRIS STREET
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-4248
Practice Address - Country:US
Practice Address - Phone:541-484-7202
Practice Address - Fax:541-484-7415
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14335204D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR157701OtherDMAP
OR157701OtherDMAP
C92477Medicare UPIN
OR0000BHWZGMedicare ID - Type Unspecified