Organization
LAKESIDE MEDICAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GAYLON E CRAWFORD D.O. (PHYSICIAN)
(928) 367-6828
Entity
Organization
Contact information
Practice address
300 W WHITE MOUNTAIN BLVD #C, LAKESIDE, AZ 85929-7014
(928) 367-6828
(928) 367-4037
Mailing address
300 W WHITE MOUNTAIN BLVD #C, LAKESIDE, AZ 85929-7014
(928) 367-6828
(928) 367-4037
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
368333
—
AZ
Enumeration date
08/25/2021
Last updated
03/16/2022
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