Provider Demographics
NPI:1063430585
Name:CROWDER, CHARLES M (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:CROWDER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:C
Other - Middle Name:MICHAEL
Other - Last Name:CROWDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST BOX 356540
Practice Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY AND PAIN MEDICINE
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195
Practice Address - Country:US
Practice Address - Phone:206-543-2673
Practice Address - Fax:206-543-2958
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60105413207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1063430585Medicaid
WA1063430585Medicaid
MO216010174Medicaid
LA430653611Medicaid
IL$$$$$$$$$Medicaid