Provider Demographics
NPI:1447258942
Name:CRUMB, CHARLES K (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:K
Last Name:CRUMB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7777 SW FREEWAY
Mailing Address - Street 2:SUITE 304
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1896
Mailing Address - Country:US
Mailing Address - Phone:713-270-4545
Mailing Address - Fax:713-270-9197
Practice Address - Street 1:7777 SW FREEWAY
Practice Address - Street 2:SUITE 304
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1896
Practice Address - Country:US
Practice Address - Phone:713-270-4545
Practice Address - Fax:713-270-9197
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2010-02-03
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
TXE0322207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114217602Medicaid
TX00BH04Medicare PIN
TXC14924Medicare UPIN