Individual
CHARLES PRENTICE CRUMPLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
709 HOLLYBROOK DR, SUITE 2301, LONGVIEW, TX 75605-2411
(903) 757-5804
(903) 232-2889
Mailing address
PO BOX 19036, BELFAST, ME 04915-4085
(903) 381-7263
(903) 381-7269
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
E6296
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126482208
—
TX
01
—
83X183
BLUE CROSS
TX
Enumeration date
08/30/2006
Last updated
11/09/2021
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