Provider Demographics
NPI:1639436785
Name:CRUM, JILL (DO)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:CRUM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20855 SW ZURICH CT
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97078-4109
Mailing Address - Country:US
Mailing Address - Phone:740-310-4395
Mailing Address - Fax:
Practice Address - Street 1:2206 KAEN RD
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4048
Practice Address - Country:US
Practice Address - Phone:503-722-6777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO1863360207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine