Provider Demographics
NPI:1780746560
Name:CRAWFORD, JOHNETTE L (MD)
Entity type:Individual
Prefix:
First Name:JOHNETTE
Middle Name:L
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOHNETTE
Other - Middle Name:
Other - Last Name:DEBOER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 84026
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-8426
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:
Practice Address - Street 1:2005 NW SAMMAMISH RD
Practice Address - Street 2:BLDG B
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5364
Practice Address - Country:US
Practice Address - Phone:425-394-0700
Practice Address - Fax:425-394-0701
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040417207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8286254Medicaid
WA0195508OtherLABOR AND INDUSTRIES
WA8852521Medicare ID - Type Unspecified
H23188Medicare UPIN