Provider Demographics
NPI:1376707042
Name:CZAR, GREGORY (PHD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:CZAR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15100 BOONES FERRY RD
Mailing Address - Street 2:SUITE 850C
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3469
Mailing Address - Country:US
Mailing Address - Phone:503-539-1547
Mailing Address - Fax:
Practice Address - Street 1:15100 BOONES FERRY RD
Practice Address - Street 2:SUITE 850C
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3469
Practice Address - Country:US
Practice Address - Phone:503-539-1547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1579103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical