Provider Demographics
NPI:1275605271
Name:CRANDALL, EARLE E (MD)
Entity Type:Individual
Prefix:DR
First Name:EARLE
Middle Name:E
Last Name:CRANDALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8920 WILSHIRE BLVD
Mailing Address - Street 2:SIUTE 418
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2007
Mailing Address - Country:US
Mailing Address - Phone:310-657-4448
Mailing Address - Fax:310-657-6812
Practice Address - Street 1:8920 WILSHIRE BLVD
Practice Address - Street 2:SIUTE 418
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2007
Practice Address - Country:US
Practice Address - Phone:310-657-4448
Practice Address - Fax:310-657-6812
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG6845207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG006845Medicare ID - Type Unspecified
CAB58115Medicare UPIN