Healthcare Provider Details

I. General information

NPI: 1831409986
Provider Name (Legal Business Name): REBECCA L CRANE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 TAMIAMI TRL N SUITE 201
NAPLES FL
34103-2817
US

IV. Provider business mailing address

5200 TAMIAMI TRL N SUITE 201
NAPLES FL
34103-2817
US

V. Phone/Fax

Practice location:
  • Phone: 239-263-6766
  • Fax: 239-263-3320
Mailing address:
  • Phone: 239-263-6766
  • Fax: 239-263-3320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number57585
License Number StateFL

VIII. Authorized Official

Name: REBECCA L CRANE
Title or Position: OWNER
Credential: MD
Phone: 239-263-6766