# BRIAN DALE CRISPELL

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1306806765
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213E00000X | Podiatrist | SC005698 | PA | — |
| 213EP1101X | Primary Podiatric Medicine Podiatrist | SC005698 | PA | — |
| 213ES0000X | Sports Medicine Podiatrist | SC005698 | PA | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | SC005698 | PA | Yes |

## Other

- **Enumeration date:** 03/27/2006
- **Last updated:** 06/13/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1015531700005 | — | PA |
| 01 | — | 329832 | MEDICARE PTAN | PA |