Healthcare Provider Details

I. General information

NPI: 1487847554
Provider Name (Legal Business Name): MELANIE ANN CRITES-BACHERT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24076 SE STARK ST SUITE 310
GRESHAM OR
97030-3373
US

IV. Provider business mailing address

3269 N STOCKTON HILL RD
KINGMAN AZ
86409-3619
US

V. Phone/Fax

Practice location:
  • Phone: 503-492-6510
  • Fax: 503-492-6502
Mailing address:
  • Phone: 928-263-4722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberDO154071
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: