Individual
TODD SHANE CROCENZI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4805 NE GLISAN ST, 6N40, PORTLAND, OR 97213-2933
(503) 215-5696
(503) 215-5695
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
MD26231
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
027918
—
OR
Enumeration date
11/02/2005
Last updated
10/29/2008
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