Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DS039762 | PA |
Y | 1223D0004X | Dentist Anesthesiologist | 1001285-15 | WI |
NPI | 1669879946 |
---|---|
Provider Name | Dr. James John Crawford |
First Address | Milwaukee, WI 53202-5732 |
Second Address | Milwaukee, WI 53202-5732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2014 |
Last Update Date | 17/03/2018 |