Provider Demographics
NPI:1396883914
Name:CRANDALL, JOY C (DO)
Entity type:Individual
Prefix:DR
First Name:JOY
Middle Name:C
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JOY
Other - Middle Name:C
Other - Last Name:WETHERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1110 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:OK
Mailing Address - Zip Code:73538-8802
Mailing Address - Country:US
Mailing Address - Phone:580-678-0438
Mailing Address - Fax:
Practice Address - Street 1:3009 NW WILSON STREET
Practice Address - Street 2:
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503
Practice Address - Country:US
Practice Address - Phone:580-458-2888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10026997207P00000X
OK4841207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine