Provider Demographics
NPI:1578695573
Name:CRAWFORD, REMBERT ALPHONSO (DPM)
Entity Type:Individual
Prefix:MR
First Name:REMBERT
Middle Name:ALPHONSO
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2328
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28380-8328
Mailing Address - Country:US
Mailing Address - Phone:910-582-0007
Mailing Address - Fax:910-582-8070
Practice Address - Street 1:16 WILLIAMS STREET
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-2526
Practice Address - Country:US
Practice Address - Phone:910-582-0007
Practice Address - Fax:910-582-8070
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC341213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08025OtherBCBS
NC890803MMedicaid
NC890803MMedicaid
NC2432586AMedicare PIN