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NPI Code Detail

MEDICARE: DR. JERRY C CRAIN D.O.

MEDICARE: DR. JERRY C CRAIN 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
1207Q00000XFamily Medicine Physician1867OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2080114764OTHEROKPALMETTO GBA-RAILROAD
3731479816001OTHEROKBLUE CROSS BLUE SHIELD
4731479816OTHEROKTRICARE

General Provider Information

NPI Number : 1578544086
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JERRY C CRAIN D.O.
Provider Business Mailing Address
First Line : 1205 W MAIN ST
Second Line :
City : COLLINSVILLE
State : OK
Zip : 74021-3114
Country : US
Telephone Number : 918-371-5885
Fax Number : 918-371-0584
Provider Business Practice Location Address
First Line : 1205 W MAIN ST
Second Line :
City : COLLINSVILLE
State : OK
Zip : 74021-3114
Country : US
Telephone Number : 918-371-5885
Fax Number : 918-371-0584
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2005
Last Update Date : 04/23/2012

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Directions to “ DR. JERRY C CRAIN D.O.” Practice Location

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