Healthcare Provider Details

I. General information

NPI: 1093083016
Provider Name (Legal Business Name): WILLIAM G CRAWFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 CRESTWOOD DR
SAINT LOUIS MO
63105-3020
US

IV. Provider business mailing address

61 CRESTWOOD DR
SAINT LOUIS MO
63105-3020
US

V. Phone/Fax

Practice location:
  • Phone: 314-221-1612
  • Fax:
Mailing address:
  • Phone: 314-221-1612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD30677
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: