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General NPI Number Information
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NPI Number | 1073889028
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Entity Type | Organization
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Legal Business Name | NAPLES GYNECOLOGY LLC
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Dates
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Enumeration Date | 03/23/2012
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Last Update Date | 03/23/2012
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Provider Practice Location Address
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Address Line | 1012 GOODLETTE RD N SUITE 101
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City | NAPLES
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State | FL
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Zip | 34102-5463
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Country | US
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Telephone | 239-214-9111
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Fax | 239-330-1360
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Provider Business Mailing Address
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Address Line | 1012 GOODLETTE RD N SUITE 101
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City | NAPLES
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State | FL
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Zip | 34102-5463
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Country | US
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Telephone | 239-214-9111
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Fax | 239-330-1360
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. BLANE MITCHELL CRANDALL
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Credential | M.D.
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Telephone | 239-213-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME95903
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License Number State | FL
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