Provider Demographics
NPI:1962491829
Name:CRUMBLISS, JOSEPH HOWE (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:HOWE
Last Name:CRUMBLISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1680 ANTILLEY RD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5267
Mailing Address - Country:US
Mailing Address - Phone:325-428-5540
Mailing Address - Fax:325-428-5545
Practice Address - Street 1:1680 ANTILLEY RD
Practice Address - Street 2:SUITE 135
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5267
Practice Address - Country:US
Practice Address - Phone:325-428-5540
Practice Address - Fax:325-428-5545
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF4797207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110352501Medicaid
TX838074Medicare PIN
TX110352501Medicaid
TXB22055Medicare UPIN