Provider Demographics
NPI:1699193326
Name:CRAIG, PAUL G (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:G
Last Name:CRAIG
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 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:400 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1334
Practice Address - Country:US
Practice Address - Phone:509-838-2531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00619662085R0202X
IDM-152222085R0202X
WAMD610056772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0425862OtherL&I-RADIA KING CTY
WA0425864OtherL&I-EVERGREEN RADIA
WA2159180Medicaid
WA0425863OtherL&I-SWEDISH RADIA EDMONDS
WA0425865OtherL&I-SOUTH SOUND RADIOLOGY
WA0425869OtherL&I-SEATTLE RADIOLOGY
WA0425859OtherL&I-RADIA REST OF WA
WA0425871OtherL&I-VANCOUVER RADIOLOGY
ID1699193326Medicaid