Healthcare Provider Details

I. General information

NPI: 1760986962
Provider Name (Legal Business Name): ALEXANDER CHRISTOPHER KRACH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 E BARNETT RD
MEDFORD OR
97504-8332
US

IV. Provider business mailing address

593 FAIRVIEW ST
ASHLAND OR
97520-2968
US

V. Phone/Fax

Practice location:
  • Phone: 541-789-7132
  • Fax: 541-789-7111
Mailing address:
  • Phone: 541-292-3977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number200642466RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: