Individual
MR. JIMMIE CONRAD CRAWFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2015 JACKSON ST, ANDERSON, IN 46016-4337
(765) 646-8439
Mailing address
514 PITNEY DR, NOBLESVILLE, IN 46062
(765) 646-8439
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002163A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2930196 00
—
FL
Enumeration date
12/20/2007
Last updated
08/21/2017
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