Provider Demographics
NPI:1841344892
Name:CRUMP, NORRIS VINCENT SR (MD)
Entity type:Individual
Prefix:MR
First Name:NORRIS
Middle Name:VINCENT
Last Name:CRUMP
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1337
Mailing Address - Street 2:898 LYNDEN BLVD
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801
Mailing Address - Country:US
Mailing Address - Phone:662-842-4427
Mailing Address - Fax:662-840-1420
Practice Address - Street 1:898 LYNDEN BLVD
Practice Address - Street 2:898 LYNDEN BLVD
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801
Practice Address - Country:US
Practice Address - Phone:662-842-4427
Practice Address - Fax:662-840-1420
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS8243207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00016859Medicaid
TN0122979OtherBCBS
73004335OtherBCBS ALA
C47972Medicare UPIN
MS112945553Medicare ID - Type Unspecified
MS110000703Medicare ID - Type Unspecified
MS253938Medicare Oscar/Certification