Provider Demographics
NPI:1932467198
Name:LEISHMAN, LISA L (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:LEISHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 STATE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8473
Mailing Address - Country:US
Mailing Address - Phone:541-842-2020
Mailing Address - Fax:541-842-2022
Practice Address - Street 1:748 STATE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8473
Practice Address - Country:US
Practice Address - Phone:541-842-2020
Practice Address - Fax:541-842-2022
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD214276207W00000X
IL036146967207W00000X
MO2013024668207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty