Provider Demographics
NPI: | 1780659532 |
---|---|
Name: | CRAWFORD, MARY E (DPM) |
Entity Type: | Individual |
Prefix: | |
First Name: | MARY |
Middle Name: | E |
Last Name: | CRAWFORD |
Suffix: | |
Gender: | F |
Credentials: | DPM |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 3131 NASSAU ST |
Mailing Address - Street 2: | SUITE #101 |
Mailing Address - City: | EVERETT |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98201-4137 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 425-339-8888 |
Mailing Address - Fax: | 425-258-6933 |
Practice Address - Street 1: | 3131 NASSAU ST |
Practice Address - Street 2: | SUITE #101 |
Practice Address - City: | EVERETT |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98201-4137 |
Practice Address - Country: | US |
Practice Address - Phone: | 425-339-8888 |
Practice Address - Fax: | 425-258-6933 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-02-22 |
Last Update Date: | 2008-01-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | PO00000419 | 213ES0103X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WA | R56231 | Other | REGENCE BLUESHIELD |
WA | 69528 | Other | WORKER'S COMPENSATION |
WA | 5912491 | Other | AETNA U.S. HEALTHCARE |
WA | 1055565 | Medicaid | |
WA | 1055565 | Medicaid |