MEDICARE: DR. CRAIG LONGRIDGE SOUTHWELL M.D.

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
1	207P00000X	Emergency Medicine Physician	MD00026911	WA

Other Identifiers

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

General Provider Information

NPI Number	:	1689755787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG LONGRIDGE SOUTHWELL M.D.

Provider Business Mailing Address
First Line	:	942 CEDAR LAKE CT SE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98501-9715
Country	:	US
Telephone Number	:	360-481-8186
Fax Number	:

Provider Business Practice Location Address
First Line	:	942 CEDAR LAKE CT SE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98501-9715
Country	:	US
Telephone Number	:	360-481-8186
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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