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NPI Code Detail

MEDICARE: MR. RYAN ROBERT CROFT PA-C

MEDICARE: MR. RYAN ROBERT CROFT PA-C
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
1363AM0700XMedical Physician AssistantPA207374OR

General Provider Information

NPI Number : 1588328314
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RYAN ROBERT CROFT PA-C
Provider Business Mailing Address
First Line : 1909 MOUNTAIN VIEW LN STE 200
Second Line :
City : FOREST GROVE
State : OR
Zip : 97116-2894
Country : US
Telephone Number : 33-594-7735
Fax Number : 503-359-3809
Provider Business Practice Location Address
First Line : 1909 MOUNTAIN VIEW LN STE 200
Second Line :
City : FOREST GROVE
State : OR
Zip : 97116-2894
Country : US
Telephone Number : 503-359-4773
Fax Number : 503-359-3809
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2021
Last Update Date : 06/03/2025

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