MEDICARE: MR. DENNIS CROZIER P.A.-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA01098	OR

General Provider Information

NPI Number	:	1033123450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DENNIS CROZIER P.A.-C

Provider Business Mailing Address
First Line	:	11790 SW BARNES RD STE 330
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97225-5935
Country	:	US
Telephone Number	:	503-228-4414
Fax Number	:	503-228-7293

Provider Business Practice Location Address
First Line	:	2120 EXCHANGE ST STE 302
Second Line	:
City	:	ASTORIA
State	:	OR
Zip	:	97103-3364
Country	:	US
Telephone Number	:	971-310-1000
Fax Number	:	100-000-0000

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/23/2020

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