Provider Demographics
NPI:1093795882
Name:BEARD-IRVINE, ERIKA STEPHANIE (MD)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:STEPHANIE
Last Name:BEARD-IRVINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 NE REVERE AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4018
Mailing Address - Country:US
Mailing Address - Phone:541-241-6371
Mailing Address - Fax:877-991-7408
Practice Address - Street 1:403 NE REVERE AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4018
Practice Address - Country:US
Practice Address - Phone:541-241-6371
Practice Address - Fax:877-991-7408
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD165872208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics