Provider Demographics
NPI:1639147903
Name:CRAWFORD, VINTON ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:VINTON
Middle Name:ANTHONY
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 1:1900 LEIGHTON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-3204
Mailing Address - Country:US
Mailing Address - Phone:256-235-8760
Mailing Address - Fax:256-235-8019
Practice Address - Street 1:1900 LEIGHTON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-3204
Practice Address - Country:US
Practice Address - Phone:256-235-8760
Practice Address - Fax:256-235-8019
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16339174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051023287OtherBLUE CROSS & BLUE SHIELD
AL000023287Medicaid
000023287Medicare ID - Type Unspecified
AL051023287OtherBLUE CROSS & BLUE SHIELD