Provider Demographics
NPI:1134137532
Name:CRAWFORD, EVERETT HOWELL JR (MD)
Entity Type:Individual
Prefix:
First Name:EVERETT
Middle Name:HOWELL
Last Name:CRAWFORD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 E LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-7706
Mailing Address - Country:US
Mailing Address - Phone:601-261-3974
Mailing Address - Fax:
Practice Address - Street 1:47 E LAKE RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7706
Practice Address - Country:US
Practice Address - Phone:601-261-3974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10257207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1558932OtherAMERICAN ADMIN GROUP
LA1032654Medicaid
MS00018568Medicaid
110022959OtherRAILROAD MEDICARE
MS1558932OtherAMERICAN ADMIN GROUP
LA1032654Medicaid
100000011Medicare ID - Type Unspecified