Individual
DR. ELIZABETH ANNE NEELEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2191 MARION ST, NORTH BEND, OR 97459-2314
(541) 756-8002
(541) 756-7503
Mailing address
913 NW GARDEN VALLEY BLVD, ROSEBURG, OR 97471-6523
(541) 963-3138
(541) 963-5918
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD16109
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
065946
—
OR
01
—
840449003
BLUE CROSS
OR
01
—
9305053253020
EMPLOYER ID
OR
01
—
H1395 03
PACIFIC SOURCE
OR
01
—
P00265715
RR MEDICARE
OR
Enumeration date
06/24/2006
Last updated
02/24/2020
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