=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528249166
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES M CRUTCHER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2007
-----------------------------------------------------
Last Update Date | 11/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 NE 10TH ST
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73117-1207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-271-4000
-----------------------------------------------------
Fax | 405-271-3431
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 NE 10TH ST
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73117-1207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-271-4000
-----------------------------------------------------
Fax | 405-271-3431
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083P0901X
-----------------------------------------------------
Taxonomy Name | Public Health & General Preventive Medicine Physician
-----------------------------------------------------
License Number | 13367
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------