Petrusek, Joseph Louis

Petrusek, Joseph Louis is an sole proprietor health care provider with primary practice located at 710 Sunset Dr Ste. D, La Grande OR 97850-1200. He recently has only one registered license in Allopathic & Osteopathic Physicians / Otolaryngology, which is considered as his primary health care specialty. Petrusek, Joseph Louis can be contacted via phone (541) 963-8643.

Contact Information

Primary practice address
710 Sunset Dr Ste. D La Grande OR 97850-1200
Phone: (541) 963-8643
Fax: (541) 963-5845
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X MD09444 Oregon

Profile Details

NPI number 1346297793
LBN Legal business name Petrusek, Joseph Louis
Credentials M.D., P.C.
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 30th, 2006
Last updated Sep 24th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346297793 NPPES
Oregon Other 009100000 BLUE CROSS PROVIDER NUMBE
Oregon Other 041913293 BLUE CROSS PROVIDER NUMBE
Oregon MEDICAID 161026 BLUE CROSS PROVIDER NUMBE

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