Provider Demographics
NPI:1548217953
Name:CRAWFORD, GREGORY LAVARR (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:LAVARR
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 BLADE AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-2003
Mailing Address - Country:US
Mailing Address - Phone:661-303-8228
Mailing Address - Fax:
Practice Address - Street 1:6412 LAUREL AVE
Practice Address - Street 2:MOUNTAIN MESA
Practice Address - City:LAKE ISABELLA
Practice Address - State:CA
Practice Address - Zip Code:93240-9529
Practice Address - Country:US
Practice Address - Phone:760-379-2681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76087207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G760870Medicaid
G01056Medicare UPIN
CACF062VMedicare PIN