Provider Demographics
NPI:1225043086
Name:TUOHY, CRAIG D (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:D
Last Name:TUOHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 GRIFFIN AVE
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-2369
Mailing Address - Country:US
Mailing Address - Phone:360-825-6511
Mailing Address - Fax:360-825-6536
Practice Address - Street 1:3021 GRIFFIN AVE
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2369
Practice Address - Country:US
Practice Address - Phone:360-825-6511
Practice Address - Fax:360-825-6536
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029574207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA110185018OtherRAILROAD
WA8929995OtherCRIME VICTIMS
WA8138240Medicaid
WA126531OtherL & I
WA126675OtherL & I
WA126709OtherL & I
WA126699OtherL & I
WAE76264Medicare UPIN
WAGAB08519Medicare PIN
WA110185018OtherRAILROAD
WA126531OtherL & I
WA126699OtherL & I
WAAB07296Medicare ID - Type Unspecified