Provider Demographics
NPI:1780662601
Name:CRAWFORD, BRUCE SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:SCOTT
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 1:645 SIERRA ROSE DR
Mailing Address - Street 2:#204
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2060
Mailing Address - Country:US
Mailing Address - Phone:775-352-9355
Mailing Address - Fax:775-352-3575
Practice Address - Street 1:645 SIERRA ROSE DR STE 204
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2060
Practice Address - Country:US
Practice Address - Phone:775-352-9355
Practice Address - Fax:775-352-3575
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9891207VG0400X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016147Medicaid
NVV37710Medicare PIN
G53615Medicare UPIN