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General NPI Number Information
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NPI Number | 1457661662
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Entity Type | Organization
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Legal Business Name | DAVID G. CRANE, INC.
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 10/21/2010
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Provider Practice Location Address
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Address Line | 802 S WASHINGTON ST
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City | BLOOMINGTON
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State | IN
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Zip | 47401-4644
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Country | US
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Telephone | 812-339-1221
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Fax |
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Provider Business Mailing Address
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Address Line | 802 S WASHINGTON ST
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City | BLOOMINGTON
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State | IN
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Zip | 47401-4644
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Country | US
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Telephone | 812-339-1221
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID G CRANE
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Credential | M.D.
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Telephone | 812-339-1221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 01019739
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License Number State | IN
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