Provider Demographics
NPI:1821050048
Name:LEHRBURGER, GERRY (MD)
Entity Type:Individual
Prefix:
First Name:GERRY
Middle Name:
Last Name:LEHRBURGER
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:PO BOX 34935
Mailing Address - Street 2:DEPARTMENT 563
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1935
Mailing Address - Country:US
Mailing Address - Phone:888-633-0079
Mailing Address - Fax:
Practice Address - Street 1:280 MAPLE ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1552
Practice Address - Country:US
Practice Address - Phone:503-482-2441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD11815207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
930079053OtherRAILROAD MEDICARE
97520A002OtherCHAMPUS
C93133OtherPROVIDENCE HEALTH PLAN
OR281410Medicaid
C93133OtherGROUP HEALTH
XPY185075OtherMEDI CAL
OR023507000OtherBC/BS OF OREGON
OR281410Medicaid
C93133OtherPROVIDENCE HEALTH PLAN