Individual
EDWARD ALAN LISENBEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
401 W POPLAR ST, PSMMC ER, WALLA WALLA, WA 99362-2846
(509) 522-5802
(509) 522-5541
Mailing address
PO BOX 34439, SEATTLE, WA 98124-1439
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD60085902
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538351606
—
WA
05
—
500615356
—
OR
Enumeration date
08/13/2007
Last updated
06/25/2014
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