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Individual

MR. PAUL ALAN CROUCH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
OTR

Contact information

Practice address
788 FOXLEY RD, HOOD RIVER, OR 97031-9722
(541) 806-0047
(541) 386-3868
Mailing address
788 FOXLEY RD, HOOD RIVER, OR 97031-9722
(541) 806-0047
(541) 386-3868

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1021091
OR
174400000X
Specialist
OT00002839
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
023087
OR
01
337703
PROVIDENCE HEALTH NUMBER
OR
01
71981
HEALTHSCAPE PROVIDER NUM
OR
05
7683501
WA
01
840393000
BCBS PROVIDER NUMBER
OR
Enumeration date
03/16/2007
Last updated
07/09/2007
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