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General NPI Number Information
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NPI Number | 1619963121
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Entity Type | Individual
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Provider Name | GARY STEPHEN CRAWFORD M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/21/2005
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Last Update Date | 01/14/2022
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Provider Practice Location Address
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Address Line | 112 MEDICAL VILLAGE DR UNIT D
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City | WALLACE
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State | NC
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Zip | 28466-1668
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Country | US
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Telephone | 910-285-7592
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Fax | 910-285-4610
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Provider Business Mailing Address
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Address Line | 125 RIVER VINE PKWY
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City | WALLACE
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State | NC
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Zip | 28466-2377
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Country | US
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Telephone | 910-285-2134
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Fax | 910-285-4610
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9401162
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License Number State | NC
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