Individual
JAY M. CRUTCHFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD FACS
Contact information
Practice address
1401 E CENTRAL DR, MERIDIAN, ID 83642-8046
(208) 795-4382
Mailing address
1401 E CENTRAL DR, MERIDIAN, ID 83642-8046
(208) 795-4382
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
21253
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020041119
RAILROAD MEDICARE
AZ
05
—
339756
—
AZ
Enumeration date
01/19/2006
Last updated
08/21/2020
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