Provider Demographics
NPI:1639322191
Name:CRAWFORD, SIMON (PA-C)
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330-6 TRACT LANE
Mailing Address - Street 2:
Mailing Address - City:ST. IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865-1029
Mailing Address - Country:US
Mailing Address - Phone:406-745-2781
Mailing Address - Fax:406-745-3080
Practice Address - Street 1:330 SIX TRACT LANE
Practice Address - Street 2:
Practice Address - City:ST. IGNATIUS
Practice Address - State:MT
Practice Address - Zip Code:59865-1029
Practice Address - Country:US
Practice Address - Phone:406-745-2781
Practice Address - Fax:406-745-3080
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT551363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant