MEDICARE: DR. JENNIFER LAUREN CRAWFORD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	N5640	TX

General Provider Information

NPI Number	:	1104922269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER LAUREN CRAWFORD MD

Provider Business Mailing Address
First Line	:	630 W 34TH ST
Second Line	:	STE 201
City	:	AUSTIN
State	:	TX
Zip	:	78705-1229
Country	:	US
Telephone Number	:	512-459-6800
Fax Number	:	512-451-9476

Provider Business Practice Location Address
First Line	:	630 W 34TH ST
Second Line	:	STE 201
City	:	AUSTIN
State	:	TX
Zip	:	78705-1229
Country	:	US
Telephone Number	:	512-459-6800
Fax Number	:	512-451-9476

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/14/2016

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