Basic Information
| Provider Information | |||||||||
| NPI: | 1952345936 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LINDBERG | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1420 NW LOVEJOY ST | ||||||||
| Address2: | LOFT 409 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972092734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032244165 | ||||||||
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| Practice Location | |||||||||
| Address1: | 470 NE A ST | ||||||||
| Address2: | |||||||||
| City: | MADRAS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977411844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414753882 | ||||||||
| FaxNumber: | 5414754804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 9683 | OR | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD00019767 | WA | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 007109 | 05 | OR | MEDICAID |