Provider Demographics
NPI:1124023049
Name:BIRECREE, ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BIRECREE
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 1:3439 NE SANDY BLVD
Mailing Address - Street 2:PMB 375
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232
Mailing Address - Country:US
Mailing Address - Phone:503-284-8841
Mailing Address - Fax:503-282-3302
Practice Address - Street 1:1020 SW TAYLOR ST
Practice Address - Street 2:STE 750
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2505
Practice Address - Country:US
Practice Address - Phone:503-288-5261
Practice Address - Fax:503-274-6536
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD155642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORF02992Medicare UPIN
ORR117183Medicare ID - Type Unspecified