Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 22756 | MN |
NPI | 1023054681 |
---|---|
Provider Name | Dr. Kenneth Crabb |
First Address | St. Paul, MN 55102-2437 |
Second Address | St. Paul, MN 55102-2437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 31/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00010438 | PREFERRED ONE (01) | MN |
07-29530 | MEDICA (01) | MN |
100613 | UCARE (01) | MN |
21593CR | BLUE SHIELD (01) | MN |
675593300 | (05) | MN |
B58568 | (02) | MN |
HP20169 | HEALTH PARTNERS (01) | MN |