Provider Demographics
NPI:1326361668
Name:BARACKER, LISA A (DO)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:BARACKER
Suffix:
Gender:
Credentials:DO
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:D
Other - Last Name:AGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 S CENTRAL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-7222
Mailing Address - Country:US
Mailing Address - Phone:541-344-9411
Mailing Address - Fax:406-247-3389
Practice Address - Street 1:160 NW FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1086
Practice Address - Country:US
Practice Address - Phone:541-344-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO220145207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine