Lakeside Medical PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LAKESIDE MEDICAL PLLC

Practice address

300 W White Mountain Blvd #C
Lakeside, AZ 85929-7014

Phone

(928) 367-6828

Fax

(928) 367-4037

NPI assigned

Aug 25, 2021

Last updated

Mar 16, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gaylon E Crawford, D.O.

Title

Physician

Phone

(928) 367-6828

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647388800000",
    "number": "1376210500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W WHITE MOUNTAIN BLVD #C",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859297014",
            "telephone_number": "928-367-6828",
            "fax_number": "928-367-4037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W WHITE MOUNTAIN BLVD #C",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859297014",
            "telephone_number": "928-367-6828",
            "fax_number": "928-367-4037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-25",
        "last_updated": "2022-03-16",
        "certification_date": "2022-03-16",
        "status": "A",
        "authorized_official_last_name": "CRAWFORD",
        "authorized_official_first_name": "GAYLON",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "928-367-6828",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "368333",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kent Walter Cox MD PS
• Thomas Melvin Kessler, M.D.
• Melissa Ann Kyrimis, MD
• Kathy Lacapa-Boegl, M.S.-CCC-SLP
• Lakeside Family Health Center PC
• Lakeside Volunteer Fire Department (Lakeside Fire District)
• Jeffrey Rayne Lesueur, M.D.
• Lincare Inc.
• Sarah Lindstrom
• LWN Medical PLLC

• Family Medicine Physician in Lakeside, AZ
• Providers in Lakeside, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.