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General NPI Number Information
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NPI Number | 1760099576
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Entity Type | Individual
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Provider Name | PERRY WILLIAM CRAWFORD PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/25/2020
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Last Update Date | 09/25/2020
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Provider Practice Location Address
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Address Line | 391 S BOLINGBROOK DR
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City | BOLINGBROOK
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State | IL
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Zip | 60440-3411
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Country | US
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Telephone | 630-226-1006
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Fax |
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Provider Business Mailing Address
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Address Line | 13525 EAGLE RIDGE DR APT 625
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City | FORT MYERS
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State | FL
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Zip | 33912-1888
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Country | US
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Telephone | 954-816-6071
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PAT-9113494
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License Number State | FL
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