Provider Demographics
NPI:1215036041
Name:CRAWFORD, LEONARD ELROY JR (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:ELROY
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 1:2800 L STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816
Mailing Address - Country:US
Mailing Address - Phone:916-453-5700
Mailing Address - Fax:916-453-5788
Practice Address - Street 1:2800 L STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816
Practice Address - Country:US
Practice Address - Phone:916-453-5700
Practice Address - Fax:916-453-5788
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31135208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00118778OtherRAILROAD MEDICARE
CA00C311350Medicaid
CA00C311350Medicaid
CA00C311352Medicare PIN