Healthcare Provider Details

I. General information

NPI: 1306951280
Provider Name (Legal Business Name): JAMES DILLON CREW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE REHAB DEPARTMENT
SAN JOSE CA
95128-2604
US

IV. Provider business mailing address

PO BOX 742502
LOS ANGELES CA
90075-2502
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-2100
  • Fax:
Mailing address:
  • Phone: 408-885-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA109047
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License NumberA109047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: