Provider Demographics
NPI:1801881230
Name:CRUMPLER, CHARLES DOUGLAS JR (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DOUGLAS
Last Name:CRUMPLER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2308 E VILLA MARIA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2549
Mailing Address - Country:US
Mailing Address - Phone:979-776-0200
Mailing Address - Fax:979-776-0400
Practice Address - Street 1:2308 E VILLA MARIA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2549
Practice Address - Country:US
Practice Address - Phone:979-776-0200
Practice Address - Fax:979-776-0400
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0046207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1739732Medicaid
TXM0046OtherSTATE LICENSE
TX1739724Medicaid
TXI31932Medicare UPIN
TX8F0253Medicare ID - Type UnspecifiedPROVIDER NUMBER
TX1739732Medicaid