Provider Demographics
NPI:1568685204
Name:CRAWFORD, JEFF (MD)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
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:PO BOX 1179
Mailing Address - Street 2:351 AIRPORT ROAD
Mailing Address - City:KEARNY
Mailing Address - State:AZ
Mailing Address - Zip Code:85237-1179
Mailing Address - Country:US
Mailing Address - Phone:520-363-9772
Mailing Address - Fax:520-363-9774
Practice Address - Street 1:351 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:AZ
Practice Address - Zip Code:85237-1179
Practice Address - Country:US
Practice Address - Phone:520-363-9772
Practice Address - Fax:520-363-9774
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18695207Q00000X
CAG53019207Q00000X
MT5268207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ006868Medicaid
Z29215Medicare ID - Type Unspecified
AZ006868Medicaid