Provider Demographics
NPI:1609130723
Name:BEAL, CRYSTAL J (MD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:J
Last Name:BEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:J
Other - Last Name:WALLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:113 CHERRY ST
Mailing Address - Street 2:PMB 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
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK141029207Q00000X
WAML60296590390200000X
WAMD60593113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program