MEDICARE: MARY J. CRAWFORD D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	R2J93	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080187042	OTHER	MO	MEDICARE RAIL ROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043208051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY J. CRAWFORD D.O.

Provider Business Mailing Address
First Line	:	102 E MARION ST
Second Line	:
City	:	PARIS
State	:	MO
Zip	:	65275-1041
Country	:	US
Telephone Number	:	660-327-4911
Fax Number	:	660-327-5501

Provider Business Practice Location Address
First Line	:	102 E MARION ST
Second Line	:
City	:	PARIS
State	:	MO
Zip	:	65275-1041
Country	:	US
Telephone Number	:	660-327-4911
Fax Number	:	660-327-5501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	04/23/2024

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