Healthcare Provider Details

I. General information

NPI: 1770671133
Provider Name (Legal Business Name): CRAIG P EBERLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 01/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 NW LARCH AVE SUITE B
REDMOND OR
97756-1323
US

IV. Provider business mailing address

PO BOX 1420
REDMOND OR
97756-0400
US

V. Phone/Fax

Practice location:
  • Phone: 541-526-6635
  • Fax: 541-526-6636
Mailing address:
  • Phone: 541-526-6635
  • Fax: 541-526-6636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD13613
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: