Criddle, Keith Jensen

Criddle, Keith Jensen is an individual health care provider with primary practice located at 202 N Division St Ste.405, Plaza 2, Auburn WA 98001-4939. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Criddle, Keith Jensen can be contacted via phone (253) 939-3604.

Contact Information

Primary practice address
202 N Division St Ste.405, Plaza 2 Auburn WA 98001-4939
Phone: (253) 939-3604
Fax: (253) 735-4167
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD00016784 Washington

Profile Details

NPI number 1760426191
LBN Legal business name Criddle, Keith Jensen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 15th, 2006
Last updated Apr 22nd, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760426191 NPPES
Washington Other 010037194 RAILROAD MEDICARE
Washington MEDICAID 8107302 RAILROAD MEDICARE

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