Healthcare Provider Details

I. General information

NPI: 1104802479
Provider Name (Legal Business Name): WILLIAM P CRAVENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 WEST HOSPITAL DRIVE SUITE A
FULTON MO
65251
US

IV. Provider business mailing address

PO BOX 6067
FULTON MO
65251-6067
US

V. Phone/Fax

Practice location:
  • Phone: 573-592-0337
  • Fax: 573-592-0711
Mailing address:
  • Phone: 573-592-0337
  • Fax: 573-592-0711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR7F41
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR7F41
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: