Provider Demographics
NPI:1851425359
Name:GAYLON E CRAWFORD DO INC
Entity Type:Organization
Organization Name:GAYLON E CRAWFORD DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAYLON
Authorized Official - Middle Name:E
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-367-2508
Mailing Address - Street 1:300 W WHITE MOUNTAIN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929
Mailing Address - Country:US
Mailing Address - Phone:928-367-2508
Mailing Address - Fax:928-367-2361
Practice Address - Street 1:300 W WHITE MOUNTAIN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929
Practice Address - Country:US
Practice Address - Phone:928-367-2508
Practice Address - Fax:928-367-2361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDO2923207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z67118Medicare UPIN