Provider Demographics
NPI:1215461967
Name:ASHCRAFT, BROOK
Entity type:Individual
Prefix:
First Name:BROOK
Middle Name:
Last Name:ASHCRAFT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 E SECTION ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-9124
Mailing Address - Country:US
Mailing Address - Phone:360-428-1700
Mailing Address - Fax:
Practice Address - Street 1:8212 S MARCH POINT RD
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-8684
Practice Address - Country:US
Practice Address - Phone:360-588-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP61090161207Q00000X
WAOL60768672207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine