MEDICARE: LEO CHARLES CRAYCHEE 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	208000000X	Pediatrics Physician	G59127	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265432710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEO CHARLES CRAYCHEE MD

Provider Business Mailing Address
First Line	:	28714 VALLEY CENTER RD
Second Line	:	#L
City	:	VALLEY CENTER
State	:	CA
Zip	:	92082-6554
Country	:	US
Telephone Number	:	760-749-7770
Fax Number	:	760-751-9988

Provider Business Practice Location Address
First Line	:	28714 VALLEY CENTER RD
Second Line	:	#F
City	:	VALLEY CENTER
State	:	CA
Zip	:	92082-6554
Country	:	US
Telephone Number	:	760-749-7770
Fax Number	:	760-751-9988

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

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	07/08/2007

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