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General NPI Number Information
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NPI Number | 1639436785
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Entity Type | Individual
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Provider Name | JILL CRUM DO
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Gender | Female
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Dates
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Enumeration Date | 04/13/2012
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 10100 SE SUNNYSIDE RD
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City | CLACKAMAS
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State | OR
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Zip | 97015-8970
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Country | US
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Telephone | 503-813-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 7234 SW NEVADA TER
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City | PORTLAND
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State | OR
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Zip | 97219-2062
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Country | US
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Telephone | 740-310-4395
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO186360
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO1863360
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License Number State | OR
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