Healthcare Provider Details

I. General information

NPI: 1043771306
Provider Name (Legal Business Name): DAVID WALTON CRASTO JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 S COMPASS WAY
DANIA FL
33004-2368
US

IV. Provider business mailing address

4030 DOGWOOD DR
JACKSON MS
39211-6607
US

V. Phone/Fax

Practice location:
  • Phone: 954-807-9433
  • Fax: 954-807-9725
Mailing address:
  • Phone: 601-613-7424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberOS17041
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: