Bancroft, Clyde Terrence

Bancroft, Clyde Terrence is an individual health care provider with primary practice located at 2570 Nw Edenbower Blvd Suite 100, Roseburg OR 97471. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Bancroft, Clyde Terrence can be contacted via phone (541) 677-7200.

Contact Information

Primary practice address
2570 Nw Edenbower Blvd Suite 100 Roseburg OR 97471
Phone: (541) 677-7200
Fax: (541) 229-3362
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA00866 Oregon

Profile Details

NPI number 1841397742
LBN Legal business name Bancroft, Clyde Terrence
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 20th, 2006
Last updated Feb 2nd, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1841397742 NPPES
Oregon MEDICAID 500601499

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