Provider Demographics
NPI:1295744209
Name:MCGORAN, CRAIG M (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:M
Last Name:MCGORAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:17900 TALBOT RD S
Mailing Address - Street 2:#102
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-8212
Mailing Address - Country:US
Mailing Address - Phone:425-255-9310
Mailing Address - Fax:425-255-6229
Practice Address - Street 1:17900 TALBOT RD S
Practice Address - Street 2:#102
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-8212
Practice Address - Country:US
Practice Address - Phone:425-255-9310
Practice Address - Fax:425-255-6229
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2011-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00036614207Q00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1109644Medicaid
8850556Medicare ID - Type Unspecified
WA1109644Medicaid