Healthcare Provider Details

I. General information

NPI: 1346551488
Provider Name (Legal Business Name): LORI CROW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 KETHLEY RD
SHAWNEE OK
74804-9638
US

IV. Provider business mailing address

PO BOX 258884
OKLAHOMA CITY OK
73125-8884
US

V. Phone/Fax

Practice location:
  • Phone: 405-273-5801
  • Fax: 405-878-3794
Mailing address:
  • Phone: 405-231-3857
  • Fax: 405-272-7977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28013
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: