Healthcare Provider Details

I. General information

NPI: 1780861914
Provider Name (Legal Business Name): BRUCE SCOTT CRAWFORD MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 SIERRA ROSE DR STE 204
RENO NV
89511-2060
US

IV. Provider business mailing address

645 SIERRA ROSE DR STE 204
RENO NV
89511-2060
US

V. Phone/Fax

Practice location:
  • Phone: 775-352-9355
  • Fax: 775-352-3575
Mailing address:
  • Phone: 775-352-9355
  • Fax: 775-352-3575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number9891
License Number StateNV

VIII. Authorized Official

Name: DR. BRUCE SCOTT CRAWFORD
Title or Position: OWNER
Credential: MD
Phone: 775-352-9355