Provider Demographics
NPI:1568440196
Name:MCCORKLE, ELIZABETH J (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:J
Last Name:MCCORKLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1030 WILLAGILLESPIE RD
Mailing Address - Street 2:WILLOW MEDICAL SPA FOR WOMEN
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2123
Mailing Address - Country:US
Mailing Address - Phone:541-653-9158
Mailing Address - Fax:541-653-8694
Practice Address - Street 1:1030 WILLAGILLESPIE RD
Practice Address - Street 2:WILLOW MEDICAL SPA FOR WOMEN
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2123
Practice Address - Country:US
Practice Address - Phone:541-653-9178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22056207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134307Medicaid
OR00890374OtherMEDICARE RAILROAD
OR149865Medicare PIN
OR134307Medicaid