Provider Demographics
NPI:1568426245
Name:CRANDALL, MARIE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-6631
Mailing Address - Fax:904-244-4687
Practice Address - Street 1:655 W. 8TH STREET
Practice Address - Street 2:DIVISION OF ACUTE CARE SURGERY
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-5975
Practice Address - Country:US
Practice Address - Phone:904-244-6631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0998302086S0102X
FL1255202086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
H45482Medicare UPIN