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General NPI Number Information
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NPI Number | 1629091665
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Entity Type | Individual
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Provider Name | RANDALL DOUGLAS CRAVER MD
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 04/17/2019
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Provider Practice Location Address
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Address Line | CHILDREN'S HOSPITAL - PATHOLOGY DEPT 200 HENRY CLAY AVE
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City | NEW ORLEANS
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State | LA
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Zip | 70118
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Country | US
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Telephone | 504-896-9815
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Fax |
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Provider Business Mailing Address
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Address Line | 200 HENRY CLAY AVE
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City | NEW ORLEANS
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State | LA
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Zip | 70118-5798
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Country | US
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Telephone | 504-899-9511
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Fax | 504-894-5119
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | MD.04626R
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License Number State | LA
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