Provider Demographics
NPI:1417926783
Name:CRAWFORD, KIMBERLY T (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:T
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6124 WEST PARKER ROAD
Mailing Address - Street 2:SUITE 234 MOB III
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8124
Mailing Address - Country:US
Mailing Address - Phone:972-981-7500
Mailing Address - Fax:972-981-3600
Practice Address - Street 1:6124 WEST PARKER ROAD
Practice Address - Street 2:SUITE 234 MOB III
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8124
Practice Address - Country:US
Practice Address - Phone:972-981-7500
Practice Address - Fax:972-981-3600
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3141207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1487817151OtherGROUP NPI
TX0064RPOtherBLUE CROSS GOUP
TX8DW621OtherBLUE CROSS
TX2010563-01Medicaid
TXTXB140228Medicare PIN
TX00Z533Medicare PIN
TX8G8168Medicare PIN
TXTXB140229Medicare PIN
TX0064RPOtherBLUE CROSS GOUP
TXTXB140230Medicare PIN