Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 13071 | TN |
N | 207Q00000X | Family Doctor | 23869 | NC |
Y | 207Q00000X | Family Doctor | 267485 | NY |
N | 207QA0401X | Family Doctor - Addiction Medicine | 267485 | NY |
NPI | 1699019729 |
---|---|
Provider Name | Dr. Joe Dean Crawford |
First Address | Rochester, NY 14624-7068 |
Second Address | Rochester, NY 14624-4176 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2012 |
Last Update Date | 24/05/2013 |