Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD18936 | OR |
Y | 208600000X | Surgeon | MD18936 | OR |
NPI | 1003805417 |
---|---|
Provider Name | Dr. Elisa A Burgess |
First Address | Portland, OR 97232-1959 |
Second Address | Lake Oswego, OR 97035-5280 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2005 |
Last Update Date | 04/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H44122 | (02) |