Individual
DR. LAZENI KOULIBALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
665 WINTER ST SE, SALEM, OR 97301-3919
(503) 561-5634
Mailing address
PO BOX 2505, SALEM, OR 97308-2505
(888) 828-3198
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
DO26795
OR
207Q00000X
Family Medicine Physician
DO26795
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006030
MARION POLK CHP
—
05
—
006030
—
OR
05
—
8460313
—
WA
Enumeration date
08/02/2006
Last updated
12/19/2007
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