Provider Demographics
NPI:1609976208
Name:KRAUSE, CHARLES EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWARD
Last Name:KRAUSE
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 1:750 SWIFT BLVD
Mailing Address - Street 2:SUITE 22
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3521
Mailing Address - Country:US
Mailing Address - Phone:509-946-2340
Mailing Address - Fax:509-946-2350
Practice Address - Street 1:750 SWIFT BLVD
Practice Address - Street 2:SUITE 22
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3521
Practice Address - Country:US
Practice Address - Phone:509-946-2340
Practice Address - Fax:509-946-2350
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0206593OtherDEPT OF L AND I
WA611588400OtherEEOICP
WAP00297263OtherRAILROAD MEDICARE
WA8859735Medicare ID - Type Unspecified
WA0206593OtherDEPT OF L AND I