Healthcare Provider Details

I. General information

NPI: 1124023049
Provider Name (Legal Business Name): ELIZABETH BIRECREE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 SW TAYLOR ST STE 750
PORTLAND OR
97205-2505
US

IV. Provider business mailing address

3439 NE SANDY BLVD PMB 375
PORTLAND OR
97232
US

V. Phone/Fax

Practice location:
  • Phone: 503-288-5261
  • Fax: 503-274-6536
Mailing address:
  • Phone: 503-284-8841
  • Fax: 503-282-3302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD15564
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: