Provider Demographics
NPI:1043399975
Name:SHAWCROSS, DUSTIN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:LEE
Last Name:SHAWCROSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11567 CANTERWOOD BLVD NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-5812
Mailing Address - Country:US
Mailing Address - Phone:253-530-2100
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:505 S 336TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5947
Practice Address - Country:US
Practice Address - Phone:800-336-8614
Practice Address - Fax:253-838-6418
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25749146D00000X
WAMD60062980207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0246652OtherLIWA
WA8951562OtherVCR
WA8537680Medicaid
WA0249327OtherLIWA
WA0249327OtherVCR
WAP00775117OtherRRGA
WA1008SHOtherBSWA
WA1044SHOtherBSWA
WA1008SHOtherBSWA
WA8879480Medicare PIN