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Dr. Charles Douglas Crumpler JR.

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NPI Number Detailed Information

Provider Information:

Name: Dr. Charles Douglas Crumpler JR.
Gender: M
Provider License Number If Given: M0046

NPI Information:

NPI: 1801881230
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 9/12/2005

Last Update Date: 7/5/2010

Provider Business Mailing Address:

Address: 2308 E VILLA MARIA RD SUITE 100
Bryan, TX 77802
Phone Number: 9797760200
Fax Number: 9797760400

Provider Business Practice Location Address:

Address: 2308 E VILLA MARIA RD SUITE 100
Bryan, TX 77802
Phone Number: 9797760200
Fax Number: 9797760400

Provider Taxonomy:

Primary: 207RE0101X
Secondary (if any):
State: TX

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