Provider Demographics
NPI:1013119916
Name:OPDYKE, KERRY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:ELIZABETH
Last Name:OPDYKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 SW MORRISON ST STE 250
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2213
Mailing Address - Country:US
Mailing Address - Phone:503-719-8574
Mailing Address - Fax:
Practice Address - Street 1:1130 SW MORRISON ST STE 250
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2213
Practice Address - Country:US
Practice Address - Phone:503-719-8574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1506802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry