Healthcare Provider Details

I. General information

NPI: 1376287920
Provider Name (Legal Business Name): MERRIT ROSS CRUMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W 24TH ST
YUMA AZ
85364-6384
US

IV. Provider business mailing address

901 W 24TH ST
YUMA AZ
85364-6384
US

V. Phone/Fax

Practice location:
  • Phone: 928-726-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number80771
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: