Individual
PORTER CRANDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
800 W JEFFERSON ST, KIRKSVILLE, MO 63501-1443
(928) 207-5621
Mailing address
1056 SNOWY ROCK RIDGE DR, SHOW LOW, AZ 85901-2915
(928) 207-5621
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/29/2024
Last updated
01/29/2024
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