Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 269383 | NY |
Y | 2086S0120X | Pediatric Surgery | MD167988 | OR |
NPI | 1659497709 |
---|---|
Provider Name | Dr. Elizabeth Anderson Fialkowski |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 14/05/2015 |