Provider Demographics
NPI:1962503235
Name:MOFFAT, KRISTI S (MD)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:S
Last Name:MOFFAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:425-899-3292
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:14720 MAIN ST NE
Practice Address - Street 2:SUITE 109
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-8460
Practice Address - Country:US
Practice Address - Phone:425-788-4889
Practice Address - Fax:425-844-6116
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00038948207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8291858Medicaid
WA8291858Medicaid
WAG8884549Medicare PIN
WAGAB34248Medicare PIN
WAG8877978Medicare PIN