Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | H9986 | TX |
N | 2080A0000X | Adolescent Medicine | H9986 | TX |
NPI | 1093773053 |
---|---|
Provider Name | Julie H. Crawford |
First Address | Dallas, TX 75373-3784 |
Second Address | Fort Worth, TX 76109-4115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 22/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F62190 | (02) | TX |