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NPI Code Detail

MEDICARE: DR. RANDALL DAVID CRIM MD

MEDICARE: DR. RANDALL DAVID CRIM 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
1207RX0202XMedical Oncology PhysicianM4745TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28AA591OTHERTXBCBSTX
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730300773
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RANDALL DAVID CRIM MD
Provider Business Mailing Address
First Line : PO BOX 911230
Second Line :
City : DALLAS
State : TX
Zip : 75391-1230
Country : US
Telephone Number : 972-997-8000
Fax Number : 972-437-9605
Provider Business Practice Location Address
First Line : 6500 HARRIS PKWY
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-4136
Country : US
Telephone Number : 817-346-6748
Fax Number : 817-263-2615
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2007
Last Update Date : 05/02/2008

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