Individual
MR. EDWARD FRAZIER SIRCHUK SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
15957 HIGHWAY 101 S STE 11, HARBOR, OR 97415-8507
(541) 813-9142
Mailing address
GENERAL DELIVERY, HARBOR, OR 97415-9999
(541) 813-9142
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
251T00000X
PACE Provider Organization
—
—
Other
Enumeration date
12/06/2024
Last updated
12/07/2024
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