Individual
ALBERT JACKSON LILLY III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
61250 SE COOMBS PL, BEND, OR 97702-3704
(541) 706-5930
(541) 706-5931
Mailing address
PO BOX 5579, BEND, OR 97708-5579
(541) 706-3700
(541) 706-3730
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD22604
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
958936
—
AZ
Enumeration date
06/13/2006
Last updated
04/17/2020
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