Organization
SISKIYOU PEDIATRIC CLINIC, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES RAY CRISPEN JR. D.O. (OWNER/PHYSICIAN)
(541) 955-5683
Entity
Organization
Contact information
Practice address
700 RAMSEY AVE STE 204, GRANTS PASS, OR 97527-5792
(541) 955-5683
(541) 955-0983
Mailing address
700 RAMSEY AVE STE 204, GRANTS PASS, OR 97527-5792
(541) 955-5683
(541) 955-0983
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
DO14538
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1487638235
KELLEY BURNETT, DO NPI
OR
01
—
1568446219
STEVEN MARSHAK, DO NPI
OR
01
—
1639153380
DEBORAH AYOLI, CPNP NPI
OK
01
—
1750365409
CHARLES CRISPEN NPI
OR
05
—
299499
—
OR
Enumeration date
08/16/2006
Last updated
08/22/2020
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