Healthcare Provider Details

I. General information

NPI: 1316994783
Provider Name (Legal Business Name): NEVILLE QUINBY CRENSHAW DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 05/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E MAIN ST
KAHOKA MO
63445-1775
US

IV. Provider business mailing address

1025 MAINE ST
QUINCY IL
62301-4038
US

V. Phone/Fax

Practice location:
  • Phone: 660-727-3388
  • Fax:
Mailing address:
  • Phone: 217-222-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR4D47
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: