Individual
DR. LISA C. SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4950 SE ROETHE RD, MILWAUKIE, OR 97267-5746
(503) 722-6858
(503) 722-6826
Mailing address
421 SW OAK ST, STE 210, PORTLAND, OR 97204-1817
(503) 988-7468
(503) 988-7468
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD24619
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
096511
—
OR
05
—
22959
—
OR
05
—
240558
—
OR
Enumeration date
10/13/2006
Last updated
06/27/2019
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