Healthcare Provider Details

I. General information

NPI: 1467112888
Provider Name (Legal Business Name): QUEERDOC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 12/27/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 CHERRY ST
SEATTLE WA
98104-2205
US

IV. Provider business mailing address

113 CHERRY ST PMBB 73332
SEATTLE WA
98104-2205
US

V. Phone/Fax

Practice location:
  • Phone: 541-604-8276
  • Fax: 352-553-4934
Mailing address:
  • Phone: 541-604-8276
  • Fax: 352-553-4934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. CRYSTAL JOY BEAL
Title or Position: PHYSICIAN
Credential: MD
Phone: 541-604-8276