Healthcare Provider Details

I. General information

NPI: 1689097339
Provider Name (Legal Business Name): MICHAEL JOE CRAWFORD P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4217 28TH AVE NW STE 111
NORMAN OK
73069-8358
US

IV. Provider business mailing address

825 E ROBINSON ST
NORMAN OK
73071-6610
US

V. Phone/Fax

Practice location:
  • Phone: 405-310-4211
  • Fax: 405-857-7215
Mailing address:
  • Phone: 405-364-7900
  • Fax: 405-310-6866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2315
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: