Provider Demographics
NPI:1265496152
Name:CRUM, JERRY DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:DEAN
Last Name:CRUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:600 NW 11TH ST
Mailing Address - Street 2:SUITE E19
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-8605
Mailing Address - Country:US
Mailing Address - Phone:541-289-7171
Mailing Address - Fax:541-289-7172
Practice Address - Street 1:600 NW 11TH ST
Practice Address - Street 2:SUITE E19
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-8605
Practice Address - Country:US
Practice Address - Phone:541-289-7171
Practice Address - Fax:541-289-7172
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2013-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG87585207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR461055178OtherTAX ID#
ORR157924Medicare UPIN