Provider Demographics
NPI:1669634796
Name:CRENSHAW, BRYAN PAUL (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:PAUL
Last Name:CRENSHAW
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 1:4126 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-9310
Mailing Address - Country:US
Mailing Address - Phone:334-793-2120
Mailing Address - Fax:334-671-2930
Practice Address - Street 1:95 SHELL RD
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-2202
Practice Address - Country:US
Practice Address - Phone:251-675-4733
Practice Address - Fax:251-679-9874
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.31084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine