NPI 1003950684

Gerald T. Lisac, MD

Practitioner Specialist West Linn, OR

Practice location

Address: 276 SW Forest Cove Rd, West Linn, OR 97068-9401
Phone: (503) 557-3679
Fax: (503) 557-3680
Mailing address: PO Box 646, West Linn, OR 97068-0646

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X Licence MD06539 (OR)

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Registry record

NPI: 1003950684
Entity type: Individual
Sex (as registered): Male
NPI issued: 16 Feb 2007
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.