Provider Demographics
NPI:1013944081
Name:CRABTREE, GLYNDA GAYE (MD)
Entity Type:Individual
Prefix:
First Name:GLYNDA
Middle Name:GAYE
Last Name:CRABTREE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:505 S 336TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6328
Mailing Address - Country:US
Mailing Address - Phone:253-838-6180
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:1253 NW CANAL BLVD
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1334
Practice Address - Country:US
Practice Address - Phone:541-548-8131
Practice Address - Fax:253-838-6418
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD23996207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286316Medicaid
OR286316Medicaid
ORR115141Medicare PIN
WAH54396Medicare UPIN