Provider Demographics
NPI:1114979952
Name:CRALL, ERIC JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JOSEPH
Last Name:CRALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4953 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558
Mailing Address - Country:US
Mailing Address - Phone:133-211-7838
Mailing Address - Fax:877-992-2302
Practice Address - Street 1:4953 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-4813
Practice Address - Country:US
Practice Address - Phone:813-321-1783
Practice Address - Fax:877-992-2302
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69527207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257348200Medicaid
FL080115587OtherRAILROAD MEDICARE NUMBER
FL257348200Medicaid
G44022Medicare UPIN