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Contact Information

CLYDE T BANCROFT, PA
2570 NW EDENBOWER BLVD
SUITE 100
ROSEBURG, OR97471
 Phone: 541-677-7200
 Fax: 541-229-3362
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for CLYDE T BANCROFT · (Male)

NPI # 1841397742
Status Active
Credentials PA (Physician Assistant)
Entity Individual
Enumeration date 09/20/2006
Last updated 02/02/2011 - About 15 years ago
Sole proprietor 1 No
Identifiers
  • OR License # PA00866
  • OR Medicaid 500601499
Hospital affiliation(s)
  • MERCY MEDICAL CENTER - (Acute Care)
    2700 NW STEWART PARKWAY
    ROSEBURG, OR 97471
  • SACRED HEART MEDICAL CENTER - RIVERBEND - (Acute Care)
    3333 RIVERBEND DRIVE
    SPRINGFIELD, OR 97477
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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