Provider Demographics
NPI:1417909599
Name:ISERI, MARC MUNROE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:MUNROE
Last Name:ISERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 SW 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914
Mailing Address - Country:US
Mailing Address - Phone:541-889-7205
Mailing Address - Fax:541-889-9204
Practice Address - Street 1:1077 SW 3RD AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914
Practice Address - Country:US
Practice Address - Phone:541-889-7205
Practice Address - Fax:541-889-9204
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2012-09-11
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-08-11
Provider Licenses
StateLicense IDTaxonomies
OR10382174400000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000BHHHPMedicare ID - Type Unspecified