Individual
DR. JASON MALCOLM CRANDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2511 NEUDORF RD STE D, CLEMMONS, NC 27012-8922
(336) 778-0506
(336) 778-0570
Mailing address
PO BOX 1741, CLEMMONS, NC 27012-1741
(336) 778-0506
(336) 778-0570
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
23500
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05667001
MAGELLAN
NC
01
—
1504998
UNITED HEALTH CARE
NC
01
—
73006
MEDCOST
NC
05
—
8925220
—
NC
01
—
MR109
BLUE CROSS EMPIRE
NC
Enumeration date
08/04/2006
Last updated
07/09/2007
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