Provider Demographics
NPI:1003012618
Name:LIPTAN, GINEVRA LOIS (MD)
Entity Type:Individual
Prefix:
First Name:GINEVRA
Middle Name:LOIS
Last Name:LIPTAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 SW CANYON CT
Mailing Address - Street 2:STE 100
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-1459
Mailing Address - Country:US
Mailing Address - Phone:503-477-9616
Mailing Address - Fax:503-477-9808
Practice Address - Street 1:6400 SW CANYON CT
Practice Address - Street 2:STE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221-1459
Practice Address - Country:US
Practice Address - Phone:503-477-9616
Practice Address - Fax:503-477-9808
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR390200000X207R00000X
OR28421208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine