Healthcare Provider Details

I. General information

NPI: 1336394949
Provider Name (Legal Business Name): ELIZABETH ANNE STRUBEL P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 BEVERLY ST STE B
SPRINGFIELD OR
97477-1910
US

IV. Provider business mailing address

2445 BEVERLY ST STE B
SPRINGFIELD OR
97477-1910
US

V. Phone/Fax

Practice location:
  • Phone: 541-780-6654
  • Fax: 541-780-6645
Mailing address:
  • Phone: 541-780-6654
  • Fax: 541-780-6645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA01419
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: