Healthcare Provider Details

I. General information

NPI: 1609592856
Provider Name (Legal Business Name): JOHN CLARK LAMASTER CRABT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 4TH ST
LONGVIEW TX
75605-5128
US

IV. Provider business mailing address

2208 JUDSON RD
LONGVIEW TX
75605-4625
US

V. Phone/Fax

Practice location:
  • Phone: 903-758-1818
  • Fax:
Mailing address:
  • Phone: 903-234-0744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246QB0000X
TaxonomyBlood Banking Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: