Healthcare Provider Details

I. General information

NPI: 1942296579
Provider Name (Legal Business Name): LISA K JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 NE HOYT ST STE 210
PORTLAND OR
97213-2980
US

IV. Provider business mailing address

7650 SW BEVELAND RD STE 200
PORTLAND OR
97223-8692
US

V. Phone/Fax

Practice location:
  • Phone: 503-249-5454
  • Fax: 503-249-5498
Mailing address:
  • Phone: 503-601-3615
  • Fax: 503-646-1683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD22958
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: