Healthcare Provider Details

I. General information

NPI: 1003106071
Provider Name (Legal Business Name): JEFFREY DAVID CRAWFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 NW SAMARITAN DR STE 201
CORVALLIS OR
97330-3771
US

IV. Provider business mailing address

PO BOX 1189
CORVALLIS OR
97339-1189
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-5930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD167580
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: