Provider Demographics
NPI:1497878342
Name:CRUM, DARRELL L (CCP)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:L
Last Name:CRUM
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 22ND ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-2317
Mailing Address - Country:US
Mailing Address - Phone:806-797-0239
Mailing Address - Fax:806-797-0239
Practice Address - Street 1:4705 22ND ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2317
Practice Address - Country:US
Practice Address - Phone:806-797-0239
Practice Address - Fax:806-797-0239
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPF0388242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist