Provider Demographics
NPI:1205832490
Name:GRUCHACZ, CATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:GRUCHACZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 ANDERSON AVE
Mailing Address - Street 2:STE #1
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-4641
Mailing Address - Country:US
Mailing Address - Phone:541-267-2400
Mailing Address - Fax:541-267-2477
Practice Address - Street 1:833 ANDERSON AVE
Practice Address - Street 2:STE #1
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-4641
Practice Address - Country:US
Practice Address - Phone:541-267-2400
Practice Address - Fax:541-267-2477
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR17150207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E93908Medicare UPIN