Healthcare Provider Details

I. General information

NPI: 1548751563
Provider Name (Legal Business Name): JAMES V. CRAWFORD, MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2018
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 NumberM-14198
License Number StateID

VIII. Authorized Official

Name: JAMES CRAWFORD
Title or Position: OWNER
Credential: MD
Phone: 208-938-5823