Healthcare Provider Details

I. General information

NPI: 1558376061
Provider Name (Legal Business Name): PAUL CRAIG DROUKAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 SW GAINES ST CDRC-P
PORTLAND OR
97239-2901
US

IV. Provider business mailing address

707 SW GAINES ST CDRC-P
PORTLAND OR
97239-2901
US

V. Phone/Fax

Practice location:
  • Phone: 503-418-5750
  • Fax: 503-494-2824
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD12253
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: