Individual
LISA M BAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9427 SW BARNES RD, SUITE 495, PORTLAND, OR 97225-6652
(503) 216-1661
(503) 216-0950
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA153729
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
153729
LICENSE
OR
05
—
500633478
—
OR
01
—
P00973898
RAILROAD MEDICARE - PHS
OR
Enumeration date
04/23/2009
Last updated
10/20/2020
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