Provider Demographics
NPI:1881674869
Name:COLGROVE, ERIC EARL (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:EARL
Last Name:COLGROVE
Suffix:
Gender:M
Credentials:MD
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 1648
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-1648
Mailing Address - Country:US
Mailing Address - Phone:541-338-7787
Mailing Address - Fax:541-684-3077
Practice Address - Street 1:1650 CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3636
Practice Address - Country:US
Practice Address - Phone:541-338-7787
Practice Address - Fax:541-684-3077
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD161353208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286359Medicaid
1881674869OtherNPI
OR286359Medicaid