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NPI Code Detail

MEDICARE: MARY WATTS CRUTCHFIELD

MEDICARE: MARY WATTS CRUTCHFIELD
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
12084P0015XPsychosomatic Medicine PhysicianG9005TX

General Provider Information

NPI Number : 1245352681
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY WATTS CRUTCHFIELD
Provider Business Mailing Address
First Line : 2237 RIDGE RD
Second Line : SUITE #101
City : ROCKWALL
State : TX
Zip : 75087-5164
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2237 RIDGE RD
Second Line : SUITE #101
City : ROCKWALL
State : TX
Zip : 75087-5164
Country : US
Telephone Number : 972-771-3969
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2007
Last Update Date : 07/08/2007

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Directions to “ MARY WATTS CRUTCHFIELD ” Practice Location

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