Provider Demographics
NPI:1306044524
Name:VANDERLIP, ERIK R (MD)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:R
Last Name:VANDERLIP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 IRVING ST
Mailing Address - Street 2:STE 600
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-8838
Mailing Address - Country:US
Mailing Address - Phone:844-966-6777
Mailing Address - Fax:
Practice Address - Street 1:1455 NW IRVING ST STE 600
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2277
Practice Address - Country:US
Practice Address - Phone:844-966-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK30537207Q00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0294142OtherL&I
OK200538200AMedicaid
WA1306044524Medicaid
WA8909123Medicare PIN