Individual
DR. WYNNE CRAWFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
273 WINTON M BLOUNT LOOP, MONTGOMERY, AL 36117-3507
(334) 280-1500
(334) 280-1600
Mailing address
PO BOX 241587, MONTGOMERY, AL 36124-1587
(334) 280-1500
(334) 280-1600
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
11019
AL
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
MD.11019
AL
207UN0901X
Nuclear Cardiology Physician
11019
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051006978
BLUE SHIELD
AL
01
—
051006979
BLUE SHIELD PROVIDER #
AL
01
—
051082953
BLUE SHIELD PROVIDER #
AL
01
—
11019
MEDICAL LICENSE
AL
05
—
82953
—
AL
Enumeration date
07/04/2006
Last updated
03/07/2023
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