Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD00029457 | WA |
N | 207YP0228X | Pediatric Otolaryngology | MD00029457 | WA |
N | 207YS0123X | Facial Plastic Surgeon | MD00029457 | WA |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | MD00029457 | WA |
NPI | 1083616072 |
---|---|
Provider Name | Dr. Robert W Craven |
First Address | Port Angeles, WA 98362-6217 |
Second Address | Port Angeles, WA 98362-6217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 12/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8235319 | (05) | WA |
E37701 | (02) | WA |