Provider Demographics
NPI:1437390333
Name:CRAYTON, JOHN WENDELL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WENDELL
Last Name:CRAYTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3926 NEW VISION DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1712
Mailing Address - Country:US
Mailing Address - Phone:260-266-8211
Mailing Address - Fax:260-458-5641
Practice Address - Street 1:2814 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-6140
Practice Address - Country:US
Practice Address - Phone:219-787-8104
Practice Address - Fax:219-787-8104
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066287A2084P0800X
IL0360482612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry