Provider Demographics
NPI:1356403455
Name:ELDER, HENRY IRWIN (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:IRWIN
Last Name:ELDER
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 1:1255 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3570
Mailing Address - Country:US
Mailing Address - Phone:541-687-6983
Mailing Address - Fax:541-684-7638
Practice Address - Street 1:1255 PEARL ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3570
Practice Address - Country:US
Practice Address - Phone:541-687-6983
Practice Address - Fax:541-684-7638
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 125432084P0800X
OR125432084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR237750Medicaid
OR237750Medicaid