Healthcare Provider Details

I. General information

NPI: 1235524703
Provider Name (Legal Business Name): CRYSTAL PICKERAL KOERNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MADISON ST STE 500
SEATTLE WA
98104-3557
US

IV. Provider business mailing address

1101 MADISON ST STE 500
SEATTLE WA
98104-3557
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-6600
  • Fax:
Mailing address:
  • Phone: 206-386-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number61033333
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: