Provider Demographics
NPI:1407062052
Name:CRITTENDEN, WILLIAM FRANKLIN
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:FRANKLIN
Last Name:CRITTENDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 W 26TH PL
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-5989
Mailing Address - Country:US
Mailing Address - Phone:928-269-6022
Mailing Address - Fax:
Practice Address - Street 1:3506 W 26TH PL
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-5989
Practice Address - Country:US
Practice Address - Phone:928-269-6022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA17101002X1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman