MEDICARE: MR. STANLEY C CRAWFORD CRNA

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	367500000X	Certified Registered Nurse Anesthetist	237594 NA	TX

General Provider Information

NPI Number	:	1497797237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STANLEY C CRAWFORD CRNA

Provider Business Mailing Address
First Line	:	9742 FM 2625 E
Second Line	:
City	:	MARSHALL
State	:	TX
Zip	:	75672-4099
Country	:	US
Telephone Number	:	903-472-0023
Fax Number	:

Provider Business Practice Location Address
First Line	:	9742 FM 2625 E
Second Line	:
City	:	MARSHALL
State	:	TX
Zip	:	75672-4099
Country	:	US
Telephone Number	:	903-472-0023
Fax Number	:

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	02/13/2017

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