Provider Demographics
NPI:1073951661
Name:CRUMRIN, TRASI LYNN (DO)
Entity Type:Individual
Prefix:
First Name:TRASI
Middle Name:LYNN
Last Name:CRUMRIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3630
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86003-3630
Mailing Address - Country:US
Mailing Address - Phone:928-522-9879
Mailing Address - Fax:928-522-9880
Practice Address - Street 1:300 S 6TH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMS
Practice Address - State:AZ
Practice Address - Zip Code:86046-0110
Practice Address - Country:US
Practice Address - Phone:928-635-4441
Practice Address - Fax:928-635-4403
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOT015181207Q00000X
MI5101022215207Q00000X
AZ008931207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine