Individual
FARA LYNN CRAWFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA04837
TX
363AS0400X
Surgical Physician Assistant
PA04837
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
280585501
—
TX
05
—
280585502
—
TX
05
—
280585503
—
TX
01
—
PA04837
STATE LICENSE
TX
Enumeration date
08/03/2006
Last updated
04/26/2012
Update your record
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