Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD00036614 | WA |
N | 207VX0000X | Obstetrician | MD00036614 | WA |
NPI | 1295744209 |
---|---|
Provider Name | Dr. Craig M Mcgoran |
First Address | Renton, WA 98055-8212 |
Second Address | Renton, WA 98055-8212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 04/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1109644 | (05) | WA |
H09069 | (02) |