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NPI Code Detail

MEDICARE: DR. KEVIN LEIGH CRANDELL M.D.

MEDICARE: DR. KEVIN LEIGH CRANDELL 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
1207Q00000XFamily Medicine Physician17870MS
2207P00000XEmergency Medicine Physician17870MS
3207P00000XEmergency Medicine Physician00024936AL
4207R00000XInternal Medicine Physician17870MS

Other Identifiers

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

General Provider Information

NPI Number : 1811955693
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEVIN LEIGH CRANDELL M.D.
Provider Business Mailing Address
First Line : 12 COUNTY ROAD 71
Second Line :
City : GOLDEN
State : MS
Zip : 38847-8310
Country : US
Telephone Number : 662-231-7878
Fax Number :
Provider Business Practice Location Address
First Line : 1701 VETERANS DR
Second Line :
City : FLORENCE
State : AL
Zip : 35630-4928
Country : US
Telephone Number : 662-231-7878
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2006
Last Update Date : 09/22/2020

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