Provider Demographics
NPI:1821187089
Name:CRONE, PAULA (DO)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:CRONE
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 1:9200 SE 91ST AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-3756
Mailing Address - Country:US
Mailing Address - Phone:503-239-7030
Mailing Address - Fax:503-239-7220
Practice Address - Street 1:9200 SE 91ST AVE
Practice Address - Street 2:STE 220
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-3756
Practice Address - Country:US
Practice Address - Phone:503-239-7030
Practice Address - Fax:503-239-7220
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO18239207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR057849Medicaid
OR058443000OtherBLUE CROSS
OR0000LGBTZMedicare ID - Type Unspecified
OR057849Medicaid