Individual
DR. ELISE JAN FULSANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
300 N GRAHAM ST, SUITE 200, PORTLAND, OR 97227-1683
(503) 413-4134
(503) 413-1895
Mailing address
24800 SE STARK ST., SUITE 200, GRESHAM, OR 97030
(503) 674-1391
(503) 413-1895
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD23553
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
232402
—
OR
Enumeration date
06/13/2005
Last updated
04/06/2011
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