Individual
KIMBERLY SUE ELTZROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
441 30TH ST, ASTORIA, OR 97103-2807
(503) 325-7800
(557) 077-5848
Mailing address
441 30TH ST, ASTORIA, OR 97103-2807
(503) 325-7800
(557) 077-5848
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD26767
OR
207V00000X
Obstetrics & Gynecology Physician
MD60413278
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005974
—
OR
Enumeration date
11/17/2005
Last updated
10/08/2021
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