Provider Demographics
NPI:1285665760
Name:VENABLE, CAROL L (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:L
Last Name:VENABLE
Suffix:
Gender:F
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:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:7320 216TH ST SW STE 200
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8006
Practice Address - Country:US
Practice Address - Phone:425-640-4900
Practice Address - Fax:425-640-4919
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60963822207R00000X, 207R00000X
NMMD2005-0839207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2157733Medicaid
CO43186548Medicaid
CO026866OtherKAISER COMMERCIAL NUMBER
COCO400003Medicare PIN