Provider Demographics
NPI:1689661738
Name:CRAWFORD, JOSEPH PUTNAM (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PUTNAM
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 1:1986 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-2533
Mailing Address - Country:US
Mailing Address - Phone:772-562-7220
Mailing Address - Fax:772-562-5476
Practice Address - Street 1:1986 35TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-2533
Practice Address - Country:US
Practice Address - Phone:772-562-7220
Practice Address - Fax:772-562-5476
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46397208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL44160100Medicaid
FL31183OtherBLUE CROSS
FL44160100Medicaid
FL31183XMedicare ID - Type Unspecified