Provider Demographics
NPI:1972949253
Name:LANTZ, GURION SETH
Entity Type:Individual
Prefix:
First Name:GURION
Middle Name:SETH
Last Name:LANTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD.
Mailing Address - Street 2:MAIL CODE L353
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239
Mailing Address - Country:US
Mailing Address - Phone:503-494-7820
Mailing Address - Fax:503-494-7829
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD.
Practice Address - Street 2:MAIL CODE L353
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-494-7820
Practice Address - Fax:503-494-7829
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60972621208G00000X
ORMD194652208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)