Provider Demographics
NPI:1497885180
Name:CRAWFORD, GUY ALVIN (PA-C)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:ALVIN
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-5449
Mailing Address - Country:US
Mailing Address - Phone:850-234-9216
Mailing Address - Fax:
Practice Address - Street 1:11111 HIGHWAY 98 EAST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407
Practice Address - Country:US
Practice Address - Phone:850-236-8655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 2457363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant