Healthcare Provider Details

I. General information

NPI: 1881199867
Provider Name (Legal Business Name): PAUL CRAVEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 05/02/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TACOMA GENERAL 315 M.L.K. JR WAY
TACOMA WA
98405
US

IV. Provider business mailing address

PO BOX 5215
TACOMA WA
98415-0215
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-8327
  • Fax:
Mailing address:
  • Phone: 253-403-8327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number29828
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD2022-0755
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD61261127
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: