Provider Demographics
NPI:1952467607
Name:ALBRICH, JERALD EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JERALD
Middle Name:EDWARD
Last Name:ALBRICH
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 1:2389 N MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-2106
Mailing Address - Country:US
Mailing Address - Phone:503-651-3531
Mailing Address - Fax:503-651-3531
Practice Address - Street 1:2389 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-2106
Practice Address - Country:US
Practice Address - Phone:503-651-3531
Practice Address - Fax:503-651-3531
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD071932085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD07193OtherLICENSE
ORMD07193OtherLICENSE