Individual
LISA D BUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 418-1472
(503) 418-1495
Mailing address
3181 SW SAM JACKSON PARK RD., MAIL CODE SJH-2, PORTLAND, OR 97239-3011
(503) 418-1472
(503) 418-1495
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA152660
OR
363AM0700X
Medical Physician Assistant
Primary
PA152660
OR
363AS0400X
Surgical Physician Assistant
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Other
Enumeration date
08/03/2010
Last updated
03/06/2022
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