Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD20498 | OR |
N | 111NI0900X | Internist | MD20498 | OR |
Y | 207RH0002X | Hospice and Palliative Medicine | MD20498 | OR |
NPI | 1205871993 |
---|---|
Provider Name | Sharon F Lissman |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97213-4742 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 14/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
136282 | (05) | OR |
G90132 | (02) |