Provider Demographics
NPI:1245243914
Name:CRAWFORD, JOHN L (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:CRAWFORD
Suffix:
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:PO BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-336-8941
Practice Address - Street 1:1325 PENNSYLVANIA AVE
Practice Address - Street 2:SUTE 720
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2144
Practice Address - Country:US
Practice Address - Phone:817-332-2998
Practice Address - Fax:817-336-8941
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG61562086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX020054432OtherRAILROAD MEDICARE
TX098662203Medicaid