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NPI Code Detail

MEDICARE: KELLY N CRAWFORD DO

MEDICARE: KELLY N CRAWFORD DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician169546OR

General Provider Information

NPI Number : 1275562142
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY N CRAWFORD DO
Provider Business Mailing Address
First Line : PO BOX 568
Second Line :
City : CORNELIUS
State : OR
Zip : 97113-0568
Country : US
Telephone Number : 503-472-1338
Fax Number : 503-434-8597
Provider Business Practice Location Address
First Line : 115 NE MAY LN
Second Line :
City : MCMINNVILLE
State : OR
Zip : 97128-9272
Country : US
Telephone Number : 503-472-1338
Fax Number : 503-434-8597
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2006
Last Update Date : 01/21/2015

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