Provider Demographics
NPI:1316088693
Name:RESENDIZ, JOSEPH E (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:E
Last Name:RESENDIZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 NW LOST SPRINGS TER STE 405
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-6558
Mailing Address - Country:US
Mailing Address - Phone:816-665-6582
Mailing Address - Fax:503-430-8189
Practice Address - Street 1:430 NW LOST SPRINGS TER STE 405
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-6558
Practice Address - Country:US
Practice Address - Phone:503-656-5273
Practice Address - Fax:503-650-4828
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO26421207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORG60676Medicare UPIN