Basic Information
| Provider Information | |||||||||
| NPI: | 1154460780 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TURNER | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9135 SW BARNES RD | ||||||||
| Address2: | #663 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972256646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032971078 | ||||||||
| FaxNumber: | 5032922176 | ||||||||
| Practice Location | |||||||||
| Address1: | 324 NW DAVIS ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972093925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032262203 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 08/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | MD22332 | OR | N | Allopathic & Osteopathic Physicians | Urology | 2084A0401X | 22332 | OR | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine |
ID Information
| ID | Type | State | Issuer | Description | 288540 | 05 | OR | MEDICAID |