Lisac, Gerald T.
Lisac, Gerald T. is an sole proprietor health care provider with primary practice located at 276 Sw Forest Cove Rd , West Linn OR 97068-9401. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Lisac, Gerald T. can be contacted via phone (503) 557-3679.Contact Information
Primary practice address
276 Sw Forest Cove Rd
West Linn OR 97068-9401
Phone: (503) 557-3679
Fax: (503) 557-3680
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | MD06539 | Oregon |
Profile Details
| NPI number | 1003950684 |
|---|---|
| LBN Legal business name | Lisac, Gerald T. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 16th, 2007 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1003950684 | NPPES |
| Oregon | Other | D72976 | PROV. HEALTH PLAN |
| Oregon | MEDICAID | 107722 | PROV. HEALTH PLAN |
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