Healthcare Provider Details

I. General information

NPI: 1831377670
Provider Name (Legal Business Name): MARK K CRAWFORD MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LOMAS BLVD NE THREE WOODWARD CENTER
ALBUQUERQUE NM
87102-2568
US

IV. Provider business mailing address

700 LOMAS BLVD NE THREE WOODWARD CENTER
ALBUQUERQUE NM
87102-2568
US

V. Phone/Fax

Practice location:
  • Phone: 505-242-1711
  • Fax: 505-242-0189
Mailing address:
  • Phone: 505-242-1711
  • Fax: 505-242-0189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number9329
License Number StateNM

VIII. Authorized Official

Name: CANRDA L THOMPSON
Title or Position: CHIEF ADMIN OFFICER
Credential:
Phone: 505-242-1711