Provider Demographics
NPI:1902142094
Name:WILLIAM NISBET M.D.,P.C.
Entity Type:Organization
Organization Name:WILLIAM NISBET M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-364-5033
Mailing Address - Street 1:960 LIBERTY ST SE STE 100
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4165
Mailing Address - Country:US
Mailing Address - Phone:503-364-5033
Mailing Address - Fax:503-364-4820
Practice Address - Street 1:960 LIBERTY ST SE STE 100
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4165
Practice Address - Country:US
Practice Address - Phone:503-364-5033
Practice Address - Fax:503-364-4820
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLIAM NISBET M.D.,P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10771208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty