Provider Demographics
NPI:1376683243
Name:CRUM, EDWARD JASON (HEALTH SERVICE TECH)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:JASON
Last Name:CRUM
Suffix:
Gender:M
Credentials:HEALTH SERVICE TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4200 OCEAN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32233-2416
Mailing Address - Country:US
Mailing Address - Phone:904-564-7581
Mailing Address - Fax:904-564-7583
Practice Address - Street 1:4200 OCEAN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32233-2416
Practice Address - Country:US
Practice Address - Phone:904-564-7581
Practice Address - Fax:904-564-7583
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB1757148146N00000X
CA247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Not Answered247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other