Provider Demographics
NPI:1326128109
Name:CRANDALL, BLANE MILTON (MD)
Entity Type:Individual
Prefix:DR
First Name:BLANE
Middle Name:MILTON
Last Name:CRANDALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1660 MEDICAL BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1415
Mailing Address - Country:US
Mailing Address - Phone:239-596-2300
Mailing Address - Fax:239-596-2301
Practice Address - Street 1:1660 MEDICAL BLVD
Practice Address - Street 2:STE 101
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1415
Practice Address - Country:US
Practice Address - Phone:239-596-2300
Practice Address - Fax:239-596-2301
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME34911207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA99359Medicare UPIN