Provider Demographics
NPI:1457589236
Name:TINDALL, ELIZABETH ANN (MD)
Entity Type:Individual
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First Name:ELIZABETH
Middle Name:ANN
Last Name:TINDALL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1980 WILLAMETTE FALLS DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4668
Mailing Address - Country:US
Mailing Address - Phone:503-638-3987
Mailing Address - Fax:503-638-2810
Practice Address - Street 1:6355 NE CORNELL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5434
Practice Address - Country:US
Practice Address - Phone:503-597-3130
Practice Address - Fax:503-597-3140
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2011-07-18
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Provider Licenses
StateLicense IDTaxonomies
OR11344207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR265074Medicaid
OR265074Medicaid