Provider Demographics
NPI:1689667271
Name:CRAWFORD, ROGER ALAN (DPM)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:ALAN
Last Name:CRAWFORD
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 1:7133 KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-2806
Mailing Address - Country:US
Mailing Address - Phone:714-527-8089
Mailing Address - Fax:714-527-8090
Practice Address - Street 1:7133 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-2806
Practice Address - Country:US
Practice Address - Phone:714-527-8089
Practice Address - Fax:714-527-8090
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1520213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10988Medicare UPIN