Provider Demographics
NPI:1356449052
Name:SHAMBAUGH, CRAIG E (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:E
Last Name:SHAMBAUGH
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 NE 72ND DR STE 9-316
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-7300
Mailing Address - Country:US
Mailing Address - Phone:360-513-1233
Mailing Address - Fax:360-906-0633
Practice Address - Street 1:3021 NE 72ND DR STE 9-316
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7300
Practice Address - Country:US
Practice Address - Phone:360-513-1233
Practice Address - Fax:360-906-0633
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23785207V00000X
WAMD00022812207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1122589Medicaid
WA8857593Medicare ID - Type Unspecified
A08159Medicare UPIN