Healthcare Provider Details

I. General information

NPI: 1861436677
Provider Name (Legal Business Name): THOMAS RAY CROW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9170 US HWY 70
WAURIKA OK
73573
US

IV. Provider business mailing address

2210 DUNCAN REGIONAL LOOP
DUNCAN OK
73533-1564
US

V. Phone/Fax

Practice location:
  • Phone: 580-228-3669
  • Fax:
Mailing address:
  • Phone: 580-251-6655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number16480
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: