Provider Demographics
NPI:1740233774
Name:TURK, JERALD ANTHONY (CRNA)
Entity Type:Individual
Prefix:
First Name:JERALD
Middle Name:ANTHONY
Last Name:TURK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51389
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-0907
Mailing Address - Country:US
Mailing Address - Phone:541-345-4343
Mailing Address - Fax:541-345-4350
Practice Address - Street 1:675 E 19TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4304
Practice Address - Country:US
Practice Address - Phone:541-284-5184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR084057658367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR36801OtherAANA #
OR150006Medicaid
OR084057658OtherRN/CRNA LICENSE #
OR150006Medicaid
OR084057658OtherRN/CRNA LICENSE #
ORR134514Medicare PIN