Provider Demographics
NPI:1053362954
Name:CRAWFORD, DAVID G (MD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:G
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:GERALD
Other - Last Name:KRANKMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 RAYOVAC DR
Mailing Address - Street 2:#103
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2479
Mailing Address - Country:US
Mailing Address - Phone:608-238-5826
Mailing Address - Fax:608-238-1221
Practice Address - Street 1:700 RAYOVAC DR
Practice Address - Street 2:#103
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2479
Practice Address - Country:US
Practice Address - Phone:608-238-5826
Practice Address - Fax:608-238-1221
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI208470202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30350700Medicaid
WI000383040Medicare ID - Type Unspecified
WI30350700Medicaid