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General NPI Number Information
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NPI Number | 1225729874
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Entity Type | Organization
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Legal Business Name | G CRENSHAW
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Dates
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Enumeration Date | 05/16/2023
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Last Update Date | 05/01/2024
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Provider Practice Location Address
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Address Line | 1108 VALENCE ST
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City | NEW ORLEANS
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State | LA
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Zip | 70115-2806
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Country | US
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Telephone | 601-672-3601
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1536
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City | MANDEVILLE
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State | LA
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Zip | 70470-1536
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Country | US
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Telephone | 985-635-6943
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | LAUREN GAST
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Credential |
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Telephone | 985-635-6943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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