Healthcare Provider Details

I. General information

NPI: 1649574674
Provider Name (Legal Business Name): MITCHELL CARLTON CRAWFORD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E. LAMAR BLVD SUITE 400
ARLINGTON TX
76006
US

IV. Provider business mailing address

PO BOX 840853
DALLAS TX
75284-0853
US

V. Phone/Fax

Practice location:
  • Phone: 888-804-3000
  • Fax: 817-877-0350
Mailing address:
  • Phone: 972-233-1999
  • Fax: 972-233-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number724314
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: