Provider Demographics
NPI:1295749695
Name:GISSEN, DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:GISSEN
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 1:2846 NW ARIEL TER
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3119
Mailing Address - Country:US
Mailing Address - Phone:775-315-4128
Mailing Address - Fax:775-883-0797
Practice Address - Street 1:2846 NW ARIEL TER
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3119
Practice Address - Country:US
Practice Address - Phone:775-883-2202
Practice Address - Fax:775-883-0797
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54203207L00000X
NV5549207L00000X
ORMD158172207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2013014Medicaid
050007310OtherRAILROAD MEDICARE
050007310OtherRAILROAD MEDICARE