Basic Information
| Provider Information | |||||||||
| NPI: | 1366975559 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROOKS | ||||||||
| FirstName: | CHRISTAL | ||||||||
| MiddleName: | VANESSA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1648 | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974401648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5416874900 | ||||||||
| FaxNumber: | 5414632820 | ||||||||
| Practice Location | |||||||||
| Address1: | 4135 QUEST DR | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974028768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414618006 | ||||||||
| FaxNumber: | 5414632198 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2017 | ||||||||
| LastUpdateDate: | 05/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | MD197707 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.