Provider Demographics
NPI:1013969021
Name:CRUM, JOSEPH D (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:D
Last Name:CRUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5000
Mailing Address - Fax:740-446-5854
Practice Address - Street 1:100 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5586
Practice Address - Fax:740-446-5749
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-5987207P00000X
WV1629207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000006632OtherANTHEM BCBS
WV0048004000Medicaid
000000185504OtherUNISON MEDICAID
OH310917085153OtherOH MEDICAID CARESOURCE
001714100OtherMOUNTAIN STATE BCBS
OH2035032Medicaid
OH2035032OtherMOLINA MEDICAID
930054111OtherRR MEDICARE
G62626Medicare UPIN
OH2035032OtherMOLINA MEDICAID