Healthcare Provider Details

I. General information

NPI: 1881918811
Provider Name (Legal Business Name): THEODORE ALEXANDER CRUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 09/14/2025
Certification Date: 09/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 N MAIN ST
ASHLAND OR
97520-1710
US

IV. Provider business mailing address

628 N MAIN ST
ASHLAND OR
97520-1710
US

V. Phone/Fax

Practice location:
  • Phone: 541-201-4930
  • Fax: 541-201-4931
Mailing address:
  • Phone: 541-201-4930
  • Fax: 541-201-4931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD198795
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: