Individual
JONATHAN KISER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1610 12TH ST SE, SALEM, OR 97302-2821
(801) 837-6395
Mailing address
1610 12TH ST SE, SALEM, OR 97302-2821
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA218086
OR
Other
Enumeration date
08/05/2022
Last updated
12/21/2023
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