Provider Demographics
NPI:1194155358
Name:CRAYTON, DESMOND
Entity type:Individual
Prefix:
First Name:DESMOND
Middle Name:
Last Name:CRAYTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 BLAIRSTONE RD
Mailing Address - Street 2:APT. 3802
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-3058
Mailing Address - Country:US
Mailing Address - Phone:850-363-7929
Mailing Address - Fax:
Practice Address - Street 1:501 BLAIRSTONE RD
Practice Address - Street 2:APT. 3802
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-3058
Practice Address - Country:US
Practice Address - Phone:850-363-7929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator