Provider Demographics
NPI:1285709386
Name:CRUMP, GARY LEE (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEE
Last Name:CRUMP
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3430 NEWBURG RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2497
Mailing Address - Country:US
Mailing Address - Phone:502-893-3963
Mailing Address - Fax:502-897-1792
Practice Address - Street 1:3430 NEWBURG RD
Practice Address - Street 2:SUITE 250
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2497
Practice Address - Country:US
Practice Address - Phone:502-893-3963
Practice Address - Fax:502-897-1792
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2013-04-26
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Provider Licenses
StateLicense IDTaxonomies
KY25740207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC74347Medicare UPIN
KY1325702Medicare ID - Type Unspecified