Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0117X | Orthopaedic Spine Surgeon | 2008004916 | MO |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 43066 | KY |
N | 207XS0117X | Orthopaedic Spine Surgeon | R0688 | KY |
N | 207XS0117X | Orthopaedic Spine Surgeon | TP699 | KY |
NPI | 1265570808 |
---|---|
Provider Name | Dr. Charles Hopkins Crawford III |
First Address | Chicago, IL 60677-6351 |
Second Address | Louisville, KY 40202-3900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2007 |
Last Update Date | 15/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000628568 | NLS/ANTHEM (01) | |
000051983K | NLSC/HUMANA (01) | |
109190 | NLSC/SIHO (01) | |
200951090 | (05) | IN |
3754853000 | NLSC/PAD (01) | |
50026895 | NLSC/PHP (01) | |
7100238200 | (05) | KY |
7157066 | NLSC/CIGNA (01) |