Provider Demographics
NPI:1225635691
Name:CRAWFORD, MARK DOUGLAS II (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DOUGLAS
Last Name:CRAWFORD
Suffix:II
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1288 WYAN RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-9052
Mailing Address - Country:US
Mailing Address - Phone:606-309-3250
Mailing Address - Fax:
Practice Address - Street 1:1288 WYAN RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40744-9052
Practice Address - Country:US
Practice Address - Phone:606-309-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant