Individual
MICHAEL P CRUISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
705 SW COAST HWY, NEWPORT, OR 97365-5017
(541) 574-4860
Mailing address
PO BOX 2847, CORVALLIS, OR 97339-2847
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
3118
AZ
363A00000X
Physician Assistant
Primary
PA01271
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500606007
—
OR
Enumeration date
11/21/2006
Last updated
12/06/2021
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