Provider Demographics
NPI:1720171937
Name:KRUSE-JARRES, REBECCA (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:KRUSE-JARRES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 TERRY AVENUE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104
Mailing Address - Country:US
Mailing Address - Phone:206-689-6507
Mailing Address - Fax:206-689-8341
Practice Address - Street 1:921 TERRY AVENUE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-292-6500
Practice Address - Fax:206-689-8365
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024803207RH0003X
WA60461062207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2036097Medicaid
LA1579742Medicaid
LA4J549Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
LA1579742Medicaid
LA1579742Medicaid