Provider Demographics
NPI:1740216449
Name:CRANDELL, MERWYN MURDOCK (MD)
Entity Type:Individual
Prefix:DR
First Name:MERWYN
Middle Name:MURDOCK
Last Name:CRANDELL
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:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-0639
Mailing Address - Country:US
Mailing Address - Phone:256-332-7350
Mailing Address - Fax:
Practice Address - Street 1:5682 HIGHWAY 73
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-6387
Practice Address - Country:US
Practice Address - Phone:256-332-7350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL108192085R0202X
GA157502085R0202X
MS026822085R0202X
OK94572085R0202X
TN66062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL35298Medicaid
AL35298Medicaid
AL35298Medicare ID - Type Unspecified