Provider Demographics
NPI:1881918811
Name:CRUM, THEODORE ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:ALEXANDER
Last Name:CRUM
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 1:595 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1821
Mailing Address - Country:US
Mailing Address - Phone:541-789-8200
Mailing Address - Fax:541-789-8201
Practice Address - Street 1:595 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1821
Practice Address - Country:US
Practice Address - Phone:541-789-8200
Practice Address - Fax:541-789-8201
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA125252207R00000X
ORMD198795207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine