Provider Demographics
NPI:1104914803
Name:QUIJANO, LERMA OCAPAN (MD)
Entity type:Individual
Prefix:DR
First Name:LERMA
Middle Name:OCAPAN
Last Name:QUIJANO
Suffix:
Gender:F
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:PO BOX 12969
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97309-0969
Mailing Address - Country:US
Mailing Address - Phone:503-399-7474
Mailing Address - Fax:503-399-0679
Practice Address - Street 1:608 LANCASTER DR SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5643
Practice Address - Country:US
Practice Address - Phone:503-399-7474
Practice Address - Fax:503-399-0679
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR10515207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC93571Medicare UPIN
OR0000BHHJKMedicare ID - Type Unspecified