Healthcare Provider Details

I. General information

NPI: 1871760587
Provider Name (Legal Business Name): JOSHUA REED CRUM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 WEDDINGTON BRANCH RD STE C
PIKEVILLE KY
41501-3296
US

IV. Provider business mailing address

PO BOX 4150
PIKEVILLE KY
41502-4150
US

V. Phone/Fax

Practice location:
  • Phone: 606-437-2401
  • Fax: 606-437-2401
Mailing address:
  • Phone: 606-437-2400
  • Fax: 606-437-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number03117
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: