Organization
ELISA A. BURGESS, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELISA A BURGESS MD (OWNER)
(503) 691-6201
Entity
Organization
Contact information
Practice address
16865 BOONES FERRY RD, STE 101, LAKE OSWEGO, OR 97035-5252
(503) 699-6464
(503) 699-6939
Mailing address
3439 NE SANDY BLVD, PMB 375, PORTLAND, OR 97232-1959
(503) 284-8841
(503) 282-3302
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
MD18936
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
262368
—
OR
Enumeration date
07/29/2006
Last updated
10/02/2008
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