Basic Information
| Provider Information | |||||||||
| NPI: | 1912996562 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRUMPACKER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5045 LORIMAR DR | ||||||||
| Address2: | SUTE 290 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750935720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724003146 | ||||||||
| FaxNumber: | 9724031465 | ||||||||
| Practice Location | |||||||||
| Address1: | 5045 LORIMAR DR | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750935720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724031463 | ||||||||
| FaxNumber: | 9724031465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2005 | ||||||||
| LastUpdateDate: | 10/16/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | J8977 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 0964246402 | 05 | TX | MEDICAID |