Provider Demographics
NPI:1760453302
Name:CRABB, DENNIS WAYNE (MD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:WAYNE
Last Name:CRABB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-1452
Mailing Address - Country:US
Mailing Address - Phone:712-263-5071
Mailing Address - Fax:712-263-6106
Practice Address - Street 1:115 N 14TH ST
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-1452
Practice Address - Country:US
Practice Address - Phone:712-263-5071
Practice Address - Fax:712-263-6106
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18961208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA18961OtherLICENSE NUMBER
IA0141002Medicaid
E47243Medicare UPIN