MEDICARE: LISA C PEW MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	MD18443	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346221355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA C PEW MD

Provider Business Mailing Address
First Line	:	7650 SW BEVELAND RD STE 200
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223-8692
Country	:	US
Telephone Number	:	503-601-3615
Fax Number	:	503-646-1683

Provider Business Practice Location Address
First Line	:	19250 SW 65TH AVE STE 300
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-7707
Country	:	US
Telephone Number	:	503-692-1242
Fax Number	:	503-691-3615

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	01/30/2026

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Directions to “ LISA C PEW MD” Practice Location

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