Healthcare Provider Details

I. General information

NPI: 1386825263
Provider Name (Legal Business Name): WARREN J KRICK MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 5TH ST
BROOKINGS OR
97415-9702
US

IV. Provider business mailing address

585 5TH ST
BROOKINGS OR
97415-9702
US

V. Phone/Fax

Practice location:
  • Phone: 541-469-5377
  • Fax: 541-469-8015
Mailing address:
  • Phone: 541-469-5377
  • Fax: 541-469-8015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD24363
License Number StateOR

VIII. Authorized Official

Name: WARREN J KRICK
Title or Position: OWNER
Credential: MD PC
Phone: 541-469-5377