Healthcare Provider Details

I. General information

NPI: 1275826125
Provider Name (Legal Business Name): THOMAS A. CRUM, PH.D., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N PARK RD SUITE 502
HOLLYWOOD FL
33021-6917
US

IV. Provider business mailing address

450 N PARK RD SUITE 502
HOLLYWOOD FL
33021-6917
US

V. Phone/Fax

Practice location:
  • Phone: 954-964-7701
  • Fax: 954-653-1413
Mailing address:
  • Phone: 954-964-7701
  • Fax: 954-653-1413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY6720
License Number StateFL

VIII. Authorized Official

Name: DR. THOMAS ALAN CRUM
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 954-964-7701