MEDICARE: JOHN DENNIE CRABTREE JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MD023887	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	020040539	OTHER	TN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	621735607	OTHER	TN	TRICARE
2	4400031002	OTHER	TN	CIGNA
4	3092513	OTHER	TN	BC/BS TN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	1740322	OTHER	TN	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1053314427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN DENNIE CRABTREE JR.

Provider Business Mailing Address
First Line	:	1750 CEDAR LN
Second Line	:	STE 100
City	:	TULLAHOMA
State	:	TN
Zip	:	37388-4760
Country	:	US
Telephone Number	:	931-455-7779
Fax Number	:	931-454-2376

Provider Business Practice Location Address
First Line	:	1750 CEDAR LN
Second Line	:	STE 100
City	:	TULLAHOMA
State	:	TN
Zip	:	37388-4760
Country	:	US
Telephone Number	:	931-455-7779
Fax Number	:	931-454-2376

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	05/18/2023

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Directions to “ JOHN DENNIE CRABTREE JR. ” Practice Location

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