Provider Demographics
NPI:1003227844
Name:CRUM, CHASE (IDC)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:
Last Name:CRUM
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS RODNEY M DAVIS
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96663-1514
Mailing Address - Country:US
Mailing Address - Phone:425-304-5010
Mailing Address - Fax:
Practice Address - Street 1:USS RODNEY M DAVIS
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96663-1514
Practice Address - Country:US
Practice Address - Phone:425-304-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman