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NPI Code Detail

MEDICARE: GARY MCCLENDON CRABTREE MD

MEDICARE: GARY MCCLENDON CRABTREE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Y00000XOtolaryngology PhysicianMD00021822WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336124361
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY MCCLENDON CRABTREE MD
Provider Business Mailing Address
First Line : 1125 S 2ND AVE STE B
Second Line :
City : WALLA WALLA
State : WA
Zip : 99362-4118
Country : US
Telephone Number : 509-529-6673
Fax Number :
Provider Business Practice Location Address
First Line : 1125 S 2ND AVE STE B
Second Line :
City : WALLA WALLA
State : WA
Zip : 99362-4118
Country : US
Telephone Number : 509-529-6673
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2005
Last Update Date : 01/28/2022

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Directions to “ GARY MCCLENDON CRABTREE MD” Practice Location

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