Healthcare Provider Details

I. General information

NPI: 1215904966
Provider Name (Legal Business Name): JAMES VINCENT CRAWFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 N SUMMERBROOK AVE STE 100
MERIDIAN ID
83642-8750
US

IV. Provider business mailing address

1209 N SUMMERBROOK AVE STE 100
MERIDIAN ID
83642-8750
US

V. Phone/Fax

Practice location:
  • Phone: 208-938-5823
  • Fax: 208-938-5306
Mailing address:
  • Phone: 208-938-5823
  • Fax: 208-938-5306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberMD00046055
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: