Provider Demographics
NPI:1821216508
Name:JOYNER, LISA CAMILLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:CAMILLE
Last Name:JOYNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2403 SE MONROE ST STE A
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7646
Mailing Address - Country:US
Mailing Address - Phone:503-659-4444
Mailing Address - Fax:503-659-1661
Practice Address - Street 1:2403 SE MONROE ST STE A
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7646
Practice Address - Country:US
Practice Address - Phone:503-659-4444
Practice Address - Fax:503-659-1661
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR MD21092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORH18990Medicare UPIN