Provider Demographics
NPI:1578530366
Name:CRUMP, MARK R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:CRUMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 757
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71711-0757
Mailing Address - Country:US
Mailing Address - Phone:870-836-8101
Mailing Address - Fax:870-837-6833
Practice Address - Street 1:353 CASH RD SW
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-3704
Practice Address - Country:US
Practice Address - Phone:870-836-8101
Practice Address - Fax:870-837-6833
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3938207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
13272000000OtherQUALCHOICE
AS770008701OtherBREASTCARE
0000167046403OtherUNITED HEALTH CARE
080046875OtherRAILROAD MEDICARE
AR115678001Medicaid
5297056OtherAETNA
13272000000OtherQUALCHOICE
AS770008701OtherBREASTCARE