MEDICARE: CATHERINE GRUCHACZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VG0400X	Gynecology Physician	17150	OR

General Provider Information

NPI Number	:	1205832490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE GRUCHACZ M.D.

Provider Business Mailing Address
First Line	:	833 ANDERSON AVE
Second Line	:	STE #1
City	:	COOS BAY
State	:	OR
Zip	:	97420-4641
Country	:	US
Telephone Number	:	541-267-2400
Fax Number	:	541-267-2477

Provider Business Practice Location Address
First Line	:	833 ANDERSON AVE
Second Line	:	STE #1
City	:	COOS BAY
State	:	OR
Zip	:	97420-4641
Country	:	US
Telephone Number	:	541-267-2400
Fax Number	:	541-267-2477

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/08/2007

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