Basic Information
| Provider Information | |||||||||
| NPI: | 1548282080 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAWFORD | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 724 S EL CAMINO REAL | ||||||||
| Address2: | |||||||||
| City: | SAN CLEMENTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926724250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494936113 | ||||||||
| FaxNumber: | 9494935851 | ||||||||
| Practice Location | |||||||||
| Address1: | 724 S EL CAMINO REAL | ||||||||
| Address2: | |||||||||
| City: | SAN CLEMENTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926724250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494936113 | ||||||||
| FaxNumber: | 9494935851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 01/27/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 20A7695 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P01391223 | 01 | CA | RR MEDICARE | OTHER |