Provider Demographics
NPI:1588328314
Name:CROFT, RYAN ROBERT (PA-C)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:ROBERT
Last Name:CROFT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1909 MOUNTAIN VIEW LN STE 200
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2894
Mailing Address - Country:US
Mailing Address - Phone:033-594-7735
Mailing Address - Fax:503-359-3809
Practice Address - Street 1:1909 MOUNTAIN VIEW LN STE 200
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2894
Practice Address - Country:US
Practice Address - Phone:503-359-4773
Practice Address - Fax:503-359-3809
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA207374363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical