Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD28446 | OR |
NPI | 1275738783 |
---|---|
Provider Name | Elizabeth Flores |
First Address | Portland, OR 97239-1454 |
Second Address | Tualatin, OR 97062-8353 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2007 |
Last Update Date | 25/10/2011 |