MEDICARE: MR. ROBERT CRANDALL DO

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	174400000X	Specialist	255	NE
2	207P00000X	Emergency Medicine Physician	255	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	06657	OTHER	NE	BLUE CROSS BLUE SHIELD NE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750383105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT CRANDALL DO

Provider Business Mailing Address
First Line	:	816 22ND AVE
Second Line	:	SUITE 100
City	:	KEARNEY
State	:	NE
Zip	:	68845-2206
Country	:	US
Telephone Number	:	308-865-2808
Fax Number	:	308-455-3970

Provider Business Practice Location Address
First Line	:	74720 G RD
Second Line	:
City	:	OVERTON
State	:	NE
Zip	:	68863-5811
Country	:	US
Telephone Number	:	308-987-2207
Fax Number	:

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	07/17/2018

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