Provider Demographics
NPI:1528049640
Name:CRIM, CATHERINE E (MD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:E
Last Name:CRIM
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 1:7650 SW BEVELAND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8692
Mailing Address - Country:US
Mailing Address - Phone:503-855-1620
Mailing Address - Fax:503-840-3299
Practice Address - Street 1:19250 SW 65TH AVE
Practice Address - Street 2:SUITE 325
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7452
Practice Address - Country:US
Practice Address - Phone:503-692-1242
Practice Address - Fax:503-691-3615
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 18265207V00000X
ORMD18265207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR058011Medicaid
ORR106590OtherMEDICARE PTAN
OR058011Medicaid