Provider Demographics
NPI:1467112888
Name:QUEERDOC PLLC
Entity Type:Organization
Organization Name:QUEERDOC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:BEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-604-8276
Mailing Address - Street 1:113 CHERRY ST
Mailing Address - Street 2:PMBB 73332
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2205
Mailing Address - Country:US
Mailing Address - Phone:541-604-8276
Mailing Address - Fax:352-553-4934
Practice Address - Street 1:113 CHERRY ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2205
Practice Address - Country:US
Practice Address - Phone:541-604-8276
Practice Address - Fax:352-553-4934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty