Individual
WALLACE VERNON CRANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 CHILDREN'S DRIVE, COLUMBUS, OH 43205-2664
(614) 722-3450
(614) 722-3454
Mailing address
700 CHILDREN'S DRIVE, COLUMBUS, OH 43205-2664
(614) 722-3450
(614) 722-3454
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
35-078095
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2196869
—
OH
05
—
6402137100
—
KY
Enumeration date
07/19/2005
Last updated
01/27/2016
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