Provider Demographics
NPI:1174114862
Name:CRAYTON, CARLTON JR
Entity type:Individual
Prefix:
First Name:CARLTON
Middle Name:
Last Name:CRAYTON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 W IVYGLEN ST APT 208
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-2146
Mailing Address - Country:US
Mailing Address - Phone:480-257-9927
Mailing Address - Fax:480-564-5911
Practice Address - Street 1:1845 E BROADWAY RD STE 116-6
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1633
Practice Address - Country:US
Practice Address - Phone:480-770-6641
Practice Address - Fax:480-546-5199
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist