Healthcare Provider Details

I. General information

NPI: 1467714253
Provider Name (Legal Business Name): CRYSTAL ANN FARRINGTON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CRYSTAL ANN GORDEN DO

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 19TH ST S
BIRMINGHAM AL
35249-6110
US

IV. Provider business mailing address

125 16TH AVE E
SEATTLE WA
98112-5211
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-4011
  • Fax:
Mailing address:
  • Phone: 206-326-3000
  • Fax: 206-326-2785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR9463
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberOP61260688
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number263624
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberDO.1714
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: