MEDICARE: ELIZABETH ANNE REDING D.O.

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	207R00000X	Internal Medicine Physician	DO156325	OR

General Provider Information

NPI Number	:	1164740817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANNE REDING D.O.

Provider Business Mailing Address
First Line	:	19250 SW 65TH AVE STE 240
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-7745
Country	:	US
Telephone Number	:	503-808-9213
Fax Number	:	971-346-4465

Provider Business Practice Location Address
First Line	:	19250 SW 65TH AVE STE 240
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-7745
Country	:	US
Telephone Number	:	503-808-9213
Fax Number	:	971-346-4465

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

Provider Enumeration Date	:	05/05/2010
Last Update Date	:	03/12/2025

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