Individual
GARY MICHAEL NISSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3333 RIVERBEND DR, SPRINGFIELD, OR 97477-8800
(541) 681-5124
Mailing address
PO BOX 7247, SPRINGFIELD, OR 97475-0011
(541) 513-7080
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD203881
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/03/2017
Last updated
03/22/2022
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