Provider Demographics
NPI:1699210443
Name:CRAWFORD CLEVELAND, MD
Entity Type:Organization
Organization Name:CRAWFORD CLEVELAND, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-469-8010
Mailing Address - Street 1:3298 SUMMIT BLVD
Mailing Address - Street 2:SUITE 40
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-8318
Mailing Address - Country:US
Mailing Address - Phone:850-469-8010
Mailing Address - Fax:
Practice Address - Street 1:3298 SUMMIT BLVD
Practice Address - Street 2:SUITE 40
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-8318
Practice Address - Country:US
Practice Address - Phone:850-469-8010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40493207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066944000Medicaid
FL17521Medicare UPIN