MEDICARE: DALE ALAN CRUISE 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	207V00000X	Obstetrics & Gynecology Physician	MD07666	OR
2	207VX0000X	Obstetrics Physician	7666	OR

General Provider Information

NPI Number	:	1629308994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALE ALAN CRUISE M.D.

Provider Business Mailing Address
First Line	:	3622 EL DORADO LOOP S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-9737
Country	:	US
Telephone Number	:	503-363-3317
Fax Number	:

Provider Business Practice Location Address
First Line	:	3622 EL DORADO LOOP S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-9737
Country	:	US
Telephone Number	:	503-363-3317
Fax Number	:

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

Provider Enumeration Date	:	01/07/2010
Last Update Date	:	01/07/2010

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Directions to “ DALE ALAN CRUISE M.D.” Practice Location

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