Healthcare Provider Details

I. General information

NPI: 1104879303
Provider Name (Legal Business Name): JULIE QUINN CRAWFORD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14541 W INDIAN SCHOOL ROAD STE 600
GOODYEAR AZ
85395-9243
US

IV. Provider business mailing address

3200 E CAMELBACK RD STE 250
PHOENIX AZ
85018-2327
US

V. Phone/Fax

Practice location:
  • Phone: 623-535-5599
  • Fax: 623-535-4696
Mailing address:
  • Phone: 602-933-1814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number33500
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number33500
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: