Individual
DR. GERALD T. LISAC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
276 SW FOREST COVE RD, WEST LINN, OR 97068-9401
(503) 557-3679
(503) 557-3680
Mailing address
PO BOX 646, WEST LINN, OR 97068-0646
(503) 557-3679
(503) 557-3680
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD06539
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
107722
—
OR
01
—
D72976
PROV. HEALTH PLAN
OR
Enumeration date
02/16/2007
Last updated
07/08/2007
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