Healthcare Provider Details

I. General information

NPI: 1497171888
Provider Name (Legal Business Name): STANLEY DOUGLAS CRAWFORD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2014
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 LOUISVILLE AVE
MONROE LA
71201-6025
US

IV. Provider business mailing address

1501 LOUISVILLE AVE
MONROE LA
71201-6025
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-8451
  • Fax: 318-361-2613
Mailing address:
  • Phone: 318-323-8451
  • Fax: 318-361-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number321723
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number321723
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: