Healthcare Provider Details

I. General information

NPI: 1750374955
Provider Name (Legal Business Name): DANIEL B CRUMP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST # MS 119
LEXINGTON KY
40536-2701
US

IV. Provider business mailing address

1221 S BROADWAY
LEXINGTON KY
40504-2701
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-1446
  • Fax: 859-257-7572
Mailing address:
  • Phone: 859-258-4000
  • Fax: 859-258-4796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number34874
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number34874
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: