Provider Demographics
NPI:1861928814
Name:TETREAULT PAQUIN, JEAN-OLIVIER (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN-OLIVIER
Middle Name:
Last Name:TETREAULT PAQUIN
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 1:5068 RUE GARNIER
Mailing Address - Street 2:
Mailing Address - City:MONTREAL
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:H2J 3S9
Mailing Address - Country:CA
Mailing Address - Phone:514-703-7813
Mailing Address - Fax:
Practice Address - Street 1:500 ARGUELLO ST
Practice Address - Street 2:SUITE 100
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1566
Practice Address - Country:US
Practice Address - Phone:650-995-1285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA145582207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine