Provider Demographics
NPI:1396797759
Name:HILL, M CRYSTAL (MD)
Entity type:Individual
Prefix:DR
First Name:M
Middle Name:CRYSTAL
Last Name:HILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 NW HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1051
Mailing Address - Country:US
Mailing Address - Phone:541-472-4777
Mailing Address - Fax:541-471-1439
Practice Address - Street 1:1701 NW HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1051
Practice Address - Country:US
Practice Address - Phone:541-472-4777
Practice Address - Fax:541-471-1439
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-30361207Q00000X
ORMD217669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200260760FMedicaid
OR500828070Medicaid
KS200260760CMedicaid
KS003768032Medicare PIN