Provider Demographics
NPI:1124249511
Name:CRASTNOPOL, JEFFREY ALAN (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:CRASTNOPOL
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 1:3405 SADDLEBROOK LN
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3034
Mailing Address - Country:US
Mailing Address - Phone:954-384-8952
Mailing Address - Fax:
Practice Address - Street 1:3405 SADDLEBROOK LN
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3034
Practice Address - Country:US
Practice Address - Phone:954-384-8952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43342207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63199Medicare UPIN