MEDICARE: ELIZABETH BIRECREE 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	MD15564	OR

General Provider Information

NPI Number	:	1124023049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH BIRECREE MD

Provider Business Mailing Address
First Line	:	3439 NE SANDY BLVD
Second Line	:	PMB 375
City	:	PORTLAND
State	:	OR
Zip	:	97232
Country	:	US
Telephone Number	:	503-284-8841
Fax Number	:	503-282-3302

Provider Business Practice Location Address
First Line	:	1020 SW TAYLOR ST
Second Line	:	STE 750
City	:	PORTLAND
State	:	OR
Zip	:	97205-2505
Country	:	US
Telephone Number	:	503-288-5261
Fax Number	:	503-274-6536

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	10/11/2007

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