Provider Demographics
NPI:1629442298
Name:ERIKA BEARD IRVINE MD LLC
Entity Type:Organization
Organization Name:ERIKA BEARD IRVINE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARD-IRVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-241-6371
Mailing Address - Street 1:325 NW VERMONT ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-1916
Mailing Address - Country:US
Mailing Address - Phone:541-241-6371
Mailing Address - Fax:877-991-7408
Practice Address - Street 1:325 NW VERMONT ST
Practice Address - Street 2:SUITE 105
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-1916
Practice Address - Country:US
Practice Address - Phone:541-241-6371
Practice Address - Fax:877-991-7408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD165872208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty