Provider Demographics
NPI:1700942786
Name:MOORE, CRAIG K (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:K
Last Name:MOORE
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:PO BOX 3175
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-3175
Mailing Address - Country:US
Mailing Address - Phone:360-676-8476
Mailing Address - Fax:
Practice Address - Street 1:1401 6TH ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7365
Practice Address - Country:US
Practice Address - Phone:360-733-2904
Practice Address - Fax:360-733-2909
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAM0026894207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1302348Medicaid
G001400478Medicare ID - Type Unspecified
WA1302348Medicaid