Provider Demographics
NPI:1831577196
Name:ERIKSON, ELIZABETH DIETRICH (DO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DIETRICH
Last Name:ERIKSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3329
Mailing Address - Country:US
Mailing Address - Phone:503-325-4321
Mailing Address - Fax:406-258-4732
Practice Address - Street 1:1639 SE ENSIGN LN STE B103
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146
Practice Address - Country:US
Practice Address - Phone:503-338-4500
Practice Address - Fax:503-338-4501
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR189802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine