Provider Demographics
NPI:1346574373
Name:LIZA SAMSON MD LLC
Entity Type:Organization
Organization Name:LIZA SAMSON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLO PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:DE LA CRUZ
Authorized Official - Last Name:SAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-705-5753
Mailing Address - Street 1:2456 NW NORTHRUP ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3253
Mailing Address - Country:US
Mailing Address - Phone:503-705-5753
Mailing Address - Fax:
Practice Address - Street 1:2456 NW NORTHRUP ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3253
Practice Address - Country:US
Practice Address - Phone:503-705-5753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22590261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care