Provider Demographics
NPI:1558353391
Name:CRUMP, MANSURA MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:MANSURA
Middle Name:MARY
Last Name:CRUMP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MANSURA
Other - Middle Name:MARY
Other - Last Name:BARKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:21120 SW 187TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-4002
Mailing Address - Country:US
Mailing Address - Phone:305-252-1393
Mailing Address - Fax:
Practice Address - Street 1:21120 SW 187TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-4002
Practice Address - Country:US
Practice Address - Phone:305-252-1393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME34297207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63365Medicare UPIN
FL95203Medicare PIN