Healthcare Provider Details

I. General information

NPI: 1376512442
Provider Name (Legal Business Name): FRED JAMES CRAPSE JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 N MAIN ST
BRISTOW OK
74010-2016
US

IV. Provider business mailing address

1809 E 13TH ST STE 300
TULSA OK
74104-4431
US

V. Phone/Fax

Practice location:
  • Phone: 918-701-2365
  • Fax: 918-367-5272
Mailing address:
  • Phone: 918-701-2313
  • Fax: 918-513-7303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number3347
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: