Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | ME64798 | FL |
Y | 207RI0011X | Interventional Cardiology | ME64798 | FL |
NPI | 1013942903 |
---|---|
Provider Name | Dr. Chauncey Warren Crandall IV |
First Address | Jupiter, FL 33458 |
Second Address | Jupiter, FL 33458 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 03/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F12368 | (02) | FL |