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General NPI Number Information
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NPI Number | 1588719413
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Entity Type | Organization
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Legal Business Name | STEVEN CRAWFORD
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 12 JEFFERSON SQ
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City | DESOTO
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State | MO
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Zip | 63020-1031
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Country | US
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Telephone | 636-586-6685
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Fax | 636-586-2780
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Provider Business Mailing Address
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Address Line | 12 JEFFERSON SQ
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City | DESOTO
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State | MO
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Zip | 63020-1031
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Country | US
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Telephone | 636-586-6685
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Fax | 636-586-2780
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEVEN D CRAWFORD
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Credential | DO
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Telephone | 636-586-6685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2002007109
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R6C68
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License Number State | MO
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