Provider Demographics
NPI:1679509145
Name:NEELEY, ELIZABETH ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANNE
Last Name:NEELEY
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 1:913 NW GARDEN VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-6523
Mailing Address - Country:US
Mailing Address - Phone:541-963-3138
Mailing Address - Fax:541-963-5918
Practice Address - Street 1:2191 MARION ST
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-2314
Practice Address - Country:US
Practice Address - Phone:541-756-8002
Practice Address - Fax:541-756-7503
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORH1395 03OtherPACIFIC SOURCE
ORP00265715OtherRR MEDICARE
OR065946Medicaid
OR9305053253020OtherEMPLOYER ID
OR840449003OtherBLUE CROSS
ORH1395 03OtherPACIFIC SOURCE