=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265566392
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BENJAMIN P CRANE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2007
-----------------------------------------------------
Last Update Date | 03/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14825 NORTH OUTER 40 ROAD SUITE 200
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63017-2154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-336-2555
-----------------------------------------------------
Fax | 314-336-2557
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14825 NORTH OUTER 40 ROAD SUITE 200
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63017-2154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-336-2555
-----------------------------------------------------
Fax | 314-336-2557
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XS0117X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery of the Spine Physician
-----------------------------------------------------
License Number | 40975
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 2008002402
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------