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General NPI Number Information
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NPI Number | 1770393902
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Entity Type | Individual
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Provider Name | MARSHALL WAYNE CRUM II CSFA
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Gender | Male
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 3100 E FLETCHER AVE
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City | TAMPA
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State | FL
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Zip | 33613-4613
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Country | US
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Telephone | 813-971-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 4109 SINGING MOCKINGBIRD BLVD
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City | BARTOW
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State | FL
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Zip | 33830-3075
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Country | US
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Telephone | 863-602-9173
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 202018
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License Number State |
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