Individual
ELIZABETH SARAH BALLNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
9205 SW BARNES RD, PORTLAND, OR 97225-6603
(503) 216-2906
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
C7-004048
DE
207R00000X
Internal Medicine Physician
DO164338
OR
208M00000X
Hospitalist Physician
Primary
DO164338
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500662274
—
OR
01
—
P01228015
RR MEDICARE - PHS
OR
Enumeration date
05/06/2008
Last updated
10/05/2020
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