Provider Demographics
NPI:1568432854
Name:KREBS, RICHARD STEWART (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:STEWART
Last Name:KREBS
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 1:2310 CRESTLINE DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-5903
Mailing Address - Country:US
Mailing Address - Phone:360-671-1221
Mailing Address - Fax:
Practice Address - Street 1:2310 CRESTLINE DR
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-5903
Practice Address - Country:US
Practice Address - Phone:360-671-1221
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017044207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1450303Medicaid
WA35055OtherL AND I
WA35055OtherL AND I
WAAB00223Medicare ID - Type Unspecified