Organization
CHESNUT MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBRA CRAWFORD (BILLING SUPERVISOR)
(509) 413-0008
Entity
Organization
Contact information
Practice address
510 S COWLEY ST STE 201, SPOKANE, WA 99202-1332
(509) 252-1299
Mailing address
510 S COWLEY ST STE 201, SPOKANE, WA 99202-1332
(509) 252-1299
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0900X
Dermatopathology Physician
—
—
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
—
—
207NP0225X
Pediatric Dermatology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
207YS0123X
Facial Plastic Surgery Physician
—
—
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
—
—
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
—
—
208200000X
Plastic Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598181828
—
UT
05
—
1952636672
—
WA
Enumeration date
01/06/2020
Last updated
12/23/2024
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