MEDICARE: DR. KERRY ELIZABETH OPDYKE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD150680	OR

General Provider Information

NPI Number	:	1013119916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KERRY ELIZABETH OPDYKE MD

Provider Business Mailing Address
First Line	:	2187 SW MAIN ST STE 203
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-1123
Country	:	US
Telephone Number	:	503-719-8574
Fax Number	:

Provider Business Practice Location Address
First Line	:	2187 SW MAIN ST STE 203
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97205-1123
Country	:	US
Telephone Number	:	503-719-8574
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2007
Last Update Date	:	07/29/2024

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