Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD 20010 | OR |
N | 207QS0010X | Family Doctor - Sports Medicine | MD20010 | OR |
NPI | 1043315690 |
---|---|
Provider Name | Dr. Lisa Burton |
First Address | Clackamas, OR 97015-9750 |
Second Address | Clackamas, OR 97015-9750 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 08/07/2007 |