Basic Information
| Provider Information | |||||||||
| NPI: | 1598775926 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RISSER | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | LEIGH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3930 SE DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972021643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034183900 | ||||||||
| FaxNumber: | 5034183939 | ||||||||
| Practice Location | |||||||||
| Address1: | 3930 SE DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972021643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034183900 | ||||||||
| FaxNumber: | 5034183939 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 01/22/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD25246 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine | 2083P0901X | MD 25246 | OR | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine |
No ID Information.