Provider Demographics
NPI:1841228376
Name:BURNS-DIESING, ELIZABETH S (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:S
Last Name:BURNS-DIESING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:S
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 SW MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5723
Mailing Address - Country:US
Mailing Address - Phone:503-225-6603
Mailing Address - Fax:
Practice Address - Street 1:100 SW MARKET ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5723
Practice Address - Country:US
Practice Address - Phone:503-225-6603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25347207R00000X
IDM11095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR027754Medicaid
ORR136305Medicare PIN