Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 48039 | CO |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 151120 | OR |
NPI | 1124165493 |
---|---|
Provider Name | Dr. Elizabeth Randi Brass |
First Address | Portland, OR 97225-6652 |
Second Address | Portland, OR 97225-6652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 23/09/2013 |