Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 17150 | OR |
NPI | 1205832490 |
---|---|
Provider Name | Catherine Gruchacz |
First Address | Coos Bay, OR 97420-4641 |
Second Address | Coos Bay, OR 97420-4641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E93908 | (02) |