1548217953 NPI number — GREGORY LAVARR CRAWFORD MD

Table of content: GREGORY LAVARR CRAWFORD MD (NPI 1548217953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548217953 NPI number — GREGORY LAVARR CRAWFORD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAWFORD
Provider First Name:
GREGORY
Provider Middle Name:
LAVARR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548217953
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3307 BLADE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93306-2003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-303-8228
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6412 LAUREL AVE
Provider Second Line Business Practice Location Address:
MOUNTAIN MESA
Provider Business Practice Location Address City Name:
LAKE ISABELLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93240-9529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-379-2681
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  G76087 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G760870 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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