Provider Demographics
NPI:1740275437
Name:CRUMP, TODD E (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:E
Last Name:CRUMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7304 W RIM DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-2043
Mailing Address - Country:US
Mailing Address - Phone:512-658-8633
Mailing Address - Fax:
Practice Address - Street 1:7304 W RIM DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-2043
Practice Address - Country:US
Practice Address - Phone:512-588-2507
Practice Address - Fax:506-700-6425
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0110207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J3022Medicare PIN
TXH60526Medicare UPIN