Healthcare Provider Details

I. General information

NPI: 1962497495
Provider Name (Legal Business Name): PAUL M CRUM JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 BARRS ST
JACKSONVILLE FL
32204-4704
US

IV. Provider business mailing address

2165 HERSCHEL ST
JACKSONVILLE FL
32204-3819
US

V. Phone/Fax

Practice location:
  • Phone: 904-387-4030
  • Fax: 904-381-9808
Mailing address:
  • Phone: 904-387-4030
  • Fax: 904-381-9808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME73333
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: