Healthcare Provider Details

I. General information

NPI: 1194393868
Provider Name (Legal Business Name): ADAM KEMP CRANDELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E MAIN ST STE A100
PAYSON AZ
85541-4606
US

IV. Provider business mailing address

117 E MAIN ST STE A100
PAYSON AZ
85541-4606
US

V. Phone/Fax

Practice location:
  • Phone: 928-596-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number010101
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: