Provider Demographics
NPI:1558450338
Name:KIMBERLY W. CRAWFORD, MD., PA.
Entity Type:Organization
Organization Name:KIMBERLY W. CRAWFORD, MD., PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:W
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-562-9602
Mailing Address - Street 1:PO BOX 650489
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32965-0489
Mailing Address - Country:US
Mailing Address - Phone:772-562-9602
Mailing Address - Fax:772-562-8086
Practice Address - Street 1:787 37TH ST STE E100
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7304
Practice Address - Country:US
Practice Address - Phone:772-562-9602
Practice Address - Fax:772-562-8086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41273207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD85607Medicare UPIN
FL31159Medicare ID - Type Unspecified