Individual
MR. ROBERT CRANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
74720 G RD, OVERTON, NE 68863-5811
(308) 987-2207
Mailing address
816 22ND AVE, SUITE 100, KEARNEY, NE 68845-2206
(308) 865-2808
(308) 455-3970
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
255
NE
207P00000X
Emergency Medicine Physician
255
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06657
BLUE CROSS BLUE SHIELD NE
NE
05
—
1750383105
—
NE
Enumeration date
08/15/2005
Last updated
07/17/2018
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