Healthcare Provider Details

I. General information

NPI: 1699210443
Provider Name (Legal Business Name): CRAWFORD CLEVELAND, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3298 SUMMIT BLVD SUITE 40
PENSACOLA FL
32503-8318
US

IV. Provider business mailing address

3298 SUMMIT BLVD SUITE 40
PENSACOLA FL
32503-8318
US

V. Phone/Fax

Practice location:
  • Phone: 850-469-8010
  • Fax:
Mailing address:
  • Phone: 850-469-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberME40493
License Number StateFL

VIII. Authorized Official

Name: CHRISTINE AMMONS
Title or Position: OFFICE MANAGER
Credential:
Phone: 850-469-8010