Provider Demographics
NPI:1285900639
Name:BLANE CRANDALL MD LLC
Entity type:Organization
Organization Name:BLANE CRANDALL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BLANE
Authorized Official - Middle Name:MILTON
Authorized Official - Last Name:CRANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-596-2300
Mailing Address - Street 1:1660 MEDICAL BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1415
Mailing Address - Country:US
Mailing Address - Phone:239-596-2300
Mailing Address - Fax:239-596-2301
Practice Address - Street 1:1660 MEDICAL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1413
Practice Address - Country:US
Practice Address - Phone:239-596-2300
Practice Address - Fax:239-596-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0034911207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05402OtherBLUE CROSS BLUE SHIELD