Healthcare Provider Details

I. General information

NPI: 1699019729
Provider Name (Legal Business Name): JOE DEAN CRAWFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DR. JOEDEAN CRAWFORD

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 HOWARD ROAD SUITE 64668
ROCHESTER NY
14624-4176
US

IV. Provider business mailing address

PO BOX 64668
ROCHESTER NY
14624-7068
US

V. Phone/Fax

Practice location:
  • Phone: 585-748-8525
  • Fax:
Mailing address:
  • Phone: 585-298-4958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number267485
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23869
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13071
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number267485
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: