Provider Demographics
NPI:1780838946
Name:GRAUER, EUGENE CARTER (NONE)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:CARTER
Last Name:GRAUER
Suffix:
Gender:M
Credentials:NONE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16525 OAKDALE RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-9644
Mailing Address - Country:US
Mailing Address - Phone:503-623-3881
Mailing Address - Fax:503-623-2751
Practice Address - Street 1:16525 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-9644
Practice Address - Country:US
Practice Address - Phone:503-623-3881
Practice Address - Fax:503-623-2751
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-532796-0905-M172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker