Provider Demographics
NPI:1740259225
Name:CRITTENDEN, JEFFREY PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:PAUL
Last Name:CRITTENDEN
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 1:400 SHADOWLINE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5089
Mailing Address - Country:US
Mailing Address - Phone:828-262-0600
Mailing Address - Fax:828-262-0807
Practice Address - Street 1:400 SHADOWLINE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5089
Practice Address - Country:US
Practice Address - Phone:828-262-0600
Practice Address - Fax:828-262-0807
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96012792084N0400X
NC772084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1144300286OtherNPI- GROUP
NC89015NTMedicaid
NC791120XOtherMEDICAID GROUP
NC130011654OtherMEDICARE RR
NC2338527OtherGROUP MEDICARE
NC2233927BMedicare PIN
NC2338527OtherGROUP MEDICARE