Provider Demographics
NPI:1609151539
Name:PERSINGER, ADAM (LMT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:PERSINGER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3834 NE SIMPSON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-7961
Mailing Address - Country:US
Mailing Address - Phone:541-954-7091
Mailing Address - Fax:
Practice Address - Street 1:3834 NE SIMPSON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-7961
Practice Address - Country:US
Practice Address - Phone:541-954-7091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11455174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist