Provider Demographics
NPI:1619056439
Name:CRAWFORD, SUSAN ANTHONY (MD)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANTHONY
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 RED CROSS PL
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3732
Mailing Address - Country:US
Mailing Address - Phone:985-735-6408
Mailing Address - Fax:
Practice Address - Street 1:100 RED CROSS PL
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3732
Practice Address - Country:US
Practice Address - Phone:985-735-6408
Practice Address - Fax:985-735-7974
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017629207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1901491Medicaid
LA1901491Medicaid
LA5N130CR24Medicare PIN