Healthcare Provider Details

I. General information

NPI: 1548266737
Provider Name (Legal Business Name): STEVEN CRAWFORD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 02/28/2022
Certification Date: 05/20/2021
Deactivation Date: 03/20/2006
Reactivation Date: 05/16/2006

III. Provider practice location address

12 JEFFERSON SQ
DE SOTO MO
63020-1031
US

IV. Provider business mailing address

12 JEFFERSON SQ
DE SOTO MO
63020-1031
US

V. Phone/Fax

Practice location:
  • Phone: 636-586-6685
  • Fax: 636-586-2780
Mailing address:
  • Phone: 636-586-6685
  • Fax: 636-586-2780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR6C68
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: