Healthcare Provider Details

I. General information

NPI: 1225043086
Provider Name (Legal Business Name): CRAIG D TUOHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 GRIFFIN AVE
ENUMCLAW WA
98022-2369
US

IV. Provider business mailing address

3021 GRIFFIN AVE
ENUMCLAW WA
98022-2369
US

V. Phone/Fax

Practice location:
  • Phone: 360-825-6511
  • Fax: 360-825-6536
Mailing address:
  • Phone: 360-825-6511
  • Fax: 360-825-6536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD00029574
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier110185018
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerRAILROAD
# 2
Identifier8929995
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerCRIME VICTIMS
# 3
Identifier8138240
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 4
Identifier126531
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerL & I
# 5
Identifier126675
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerL & I
# 6
Identifier126709
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerL & I
# 7
Identifier126699
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerL & I

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: