Provider Demographics
NPI:1144647132
Name:CREWDSON, GREGORY (DO)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:CREWDSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:GREGORY
Other - Middle Name:
Other - Last Name:CREWDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:7235 OHMS LN
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2148
Mailing Address - Country:US
Mailing Address - Phone:952-260-1381
Mailing Address - Fax:
Practice Address - Street 1:1725 LEGACY PKWY E STE 100
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-5434
Practice Address - Country:US
Practice Address - Phone:952-260-1381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-05402207LP2900X, 208VP0014X
MN72348207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1144647132Medicaid