Individual
LANCE GREGORY LOBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9605 GRAND RONDE RD, GRAND RONDE, OR 97347-9712
(503) 879-2002
Mailing address
1002 BELLEVUE ST SE, SALEM, OR 97301-4006
(503) 561-5554
(503) 561-4824
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD13309
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023015
—
OR
05
—
267195
—
OR
Enumeration date
11/08/2005
Last updated
06/07/2021
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