Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | ME43342 | FL |
NPI | 1124249511 |
---|---|
Provider Name | Jeffrey Alan Crastnopol |
First Address | Weston, FL 33331-3034 |
Second Address | Weston, FL 33331-3034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D63199 | (02) | FL |