Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 34461 | KY |
NPI | 1326144502 |
---|---|
Provider Name | William J Crump JR. |
First Address | Madisonville, KY 42431-1661 |
Second Address | Madisonville, KY 42431-1661 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 03/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000044260 | BCBS PROVIDER NUMBER (01) | |
34461 | LICENSE (01) | KY |
649862868 | (05) | KY |
A98910 | (02) |