Provider Demographics
NPI:1922047489
Name:CRABB, JAMES LUTHER (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LUTHER
Last Name:CRABB
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 1:36 NORTHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-4450
Mailing Address - Country:US
Mailing Address - Phone:731-394-4596
Mailing Address - Fax:
Practice Address - Street 1:176 W UNIVERSITY PKWY STE C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1618
Practice Address - Country:US
Practice Address - Phone:731-660-6915
Practice Address - Fax:731-668-4557
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN07971207P00000X
TNMD7971207Q00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4175853OtherBCBS
TNP00233179OtherRAILROAD MEDICARE
TN4108241OtherBCBS
TN31528111OtherMEDICAID
TN3152816Medicaid
TN3152816Medicare PIN
TN3152816Medicaid
TN31528111OtherMEDICAID