Healthcare Provider Details

I. General information

NPI: 1881663664
Provider Name (Legal Business Name): LISA L CRAWFORD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 06/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 W 11TH ST
TULSA OK
74127-9014
US

IV. Provider business mailing address

2345 SOUTHWEST BLVD
TULSA OK
74107-2705
US

V. Phone/Fax

Practice location:
  • Phone: 918-382-3100
  • Fax:
Mailing address:
  • Phone: 918-582-1980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3455
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: