=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790916922
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEBRA A CRAWFORD, DO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2009
-----------------------------------------------------
Last Update Date | 08/05/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4417 W GORE BLVD STE 3
-----------------------------------------------------
City | LAWTON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73505-5978
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-357-1002
-----------------------------------------------------
Fax | 580-357-1004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4417 W GORE BLVD STE 3
-----------------------------------------------------
City | LAWTON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73505-5978
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-357-1002
-----------------------------------------------------
Fax | 580-357-1004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. DEBRA A CRAWFORD
-----------------------------------------------------
Credential | DO LLC
-----------------------------------------------------
Telephone | 580-357-1002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 4396
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------