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NPI Code Detail

MEDICARE: DR. ELIZABETH TYRELL PENDRAGON MD

MEDICARE: DR. ELIZABETH TYRELL PENDRAGON 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
1207Q00000XFamily Medicine PhysicianA65070CA
2207Q00000XFamily Medicine PhysicianMD208773OR

General Provider Information

NPI Number : 1801841960
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIZABETH TYRELL PENDRAGON MD
Provider Business Mailing Address
First Line : 444 NW ELKS DR
Second Line :
City : CORVALLIS
State : OR
Zip : 97330-3745
Country : US
Telephone Number : 541-754-1150
Fax Number :
Provider Business Practice Location Address
First Line : 633 N ALBANY RD NW
Second Line :
City : ALBANY
State : OR
Zip : 97321-1433
Country : US
Telephone Number : 541-926-3441
Fax Number : 541-926-1010
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2006
Last Update Date : 05/02/2022

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