Individual
GARY CRANDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
12 HOPE DR, BAGDAD, AZ 86321
(928) 633-4111
Mailing address
PO BOX 1169, 1891 BIGLER LANE, HEBER, AZ 85928-1169
(928) 633-5922
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2203
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
567753
—
AZ
Enumeration date
07/19/2006
Last updated
09/02/2008
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