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NPI Code Detail

MEDICARE: DR. GARRY CRUMMER M.D.

MEDICARE: DR. GARRY CRUMMER M.D.
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
1208000000XPediatrics PhysicianA60687CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100A606870OTHERCAMEDI-CAL ID NUMBER

General Provider Information

NPI Number : 1699878579
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARRY CRUMMER M.D.
Provider Business Mailing Address
First Line : PO BOX 541
Second Line :
City : SANTA CRUZ
State : CA
Zip : 95061-0541
Country : US
Telephone Number : 831-427-3500
Fax Number :
Provider Business Practice Location Address
First Line : 1510 CAPITOLA RD
Second Line :
City : SANTA CRUZ
State : CA
Zip : 95062-2912
Country : US
Telephone Number : 831-427-3500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2006
Last Update Date : 03/13/2024

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