Basic Information
Provider Information
NPI: 1932360526
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CRABTREE
FirstName: SCOTT
MiddleName: JAMES
NamePrefix: DR.
NameSuffix: JR.
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 101 BODIN CIR
Address2:  
City: TRAVIS AFB
State: CA
PostalCode: 945351809
CountryCode: US
TelephoneNumber: 7074233850
FaxNumber:  
Practice Location
Address1: 101 BODIN CIR
Address2:  
City: TRAVIS AFB
State: CA
PostalCode: 945351809
CountryCode: US
TelephoneNumber: 7074233735
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/17/2008
LastUpdateDate: 11/03/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X0101246776VAN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RI0200X0101246776VAY Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease

No ID Information.


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