Individual
DALE LISONBEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1350 TEAKWOOD AVE, COOS BAY, OR 97420-2537
(541) 266-4019
Mailing address
1350 TEAKWOOD AVE, COOS BAY, OR 97420-2537
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
21124
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121108
—
OR
Enumeration date
09/09/2014
Last updated
09/09/2014
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