Provider Demographics
NPI:1629044870
Name:CRUMP, VINCENT G (DPM)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:G
Last Name:CRUMP
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 1:1735 BRANDON TRACE AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2027
Mailing Address - Country:US
Mailing Address - Phone:813-416-0207
Mailing Address - Fax:813-881-9118
Practice Address - Street 1:1735 BRANDON TRACE AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-2027
Practice Address - Country:US
Practice Address - Phone:813-416-0207
Practice Address - Fax:813-881-9118
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2083213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340200200Medicaid
FL65182AMedicare ID - Type Unspecified
FL340200200Medicaid