Provider Demographics
NPI:1811955693
Name:CRANDELL, KEVIN LEIGH (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LEIGH
Last Name:CRANDELL
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 1:12 COUNTY ROAD 71
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:MS
Mailing Address - Zip Code:38847-8310
Mailing Address - Country:US
Mailing Address - Phone:662-231-7878
Mailing Address - Fax:
Practice Address - Street 1:1701 VETERANS DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-4928
Practice Address - Country:US
Practice Address - Phone:662-231-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17870207Q00000X, 207P00000X, 207R00000X
AL00024936207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51556046Medicaid
AL51556046Medicaid