Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AT-AT-10152547 | OR |
Y | 213ES0000X | Sports Medicine | AT-AT-10152547 | OR |
NPI | 1073145447 |
---|---|
Provider Name | Elizabeth Corbett-Furgal |
First Address | Portland, OR 97211-6067 |
Second Address | Portland, OR 97211-6067 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2020 |
Last Update Date | 04/02/2020 |