=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326301680
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRYSTAL DAWN SCHWARTZ D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2012
-----------------------------------------------------
Last Update Date | 09/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1401 N 10TH AVE
-----------------------------------------------------
City | STAYTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-769-2175
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2100 NW LEWISBURG AVE
-----------------------------------------------------
City | CORVALLIS
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97330-9783
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-745-8732
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | DO176633
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------