Provider Demographics
NPI:1750399770
Name:CRENSHAW, ERIKA WUNDERLICH (MD)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:WUNDERLICH
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:421 WEST COLLEGE ST
Mailing Address - Street 2:INFANTS AND CHILDRENS CLINIC PC
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630
Mailing Address - Country:US
Mailing Address - Phone:256-764-9522
Mailing Address - Fax:256-764-1139
Practice Address - Street 1:421 WEST COLLEGE ST
Practice Address - Street 2:INFANTS AND CHILDRENS CLINIC PC
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630
Practice Address - Country:US
Practice Address - Phone:256-764-9522
Practice Address - Fax:256-764-1139
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL17493208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000030952Medicaid
AL51030952OtherBC
AL000030952Medicaid