Provider Demographics
NPI:1972769552
Name:EBERHARDT DE MASTER, JOY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOY
Middle Name:ELIZABETH
Last Name:EBERHARDT DE MASTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOY
Other - Middle Name:ELIZABETH
Other - Last Name:DE MASTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2800 N VANCOUVER AVE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1630
Mailing Address - Country:US
Mailing Address - Phone:503-276-9000
Mailing Address - Fax:
Practice Address - Street 1:2800 N VANCOUVER AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1630
Practice Address - Country:US
Practice Address - Phone:503-276-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-02
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD29356208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500624709Medicaid