MEDICARE: MR. STANLEY J CROWN MD

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
1	207Q00000X	Family Medicine Physician	104161	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	26D2006074	OTHER	MO	CLIA

General Provider Information

NPI Number	:	1336233584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STANLEY J CROWN MD

Provider Business Mailing Address
First Line	:	1137 INDEPENDENCE DR
Second Line	:
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-4221
Country	:	US
Telephone Number	:	417-255-8464
Fax Number	:	417-255-9741

Provider Business Practice Location Address
First Line	:	1905 W 19TH ST
Second Line	:
City	:	MOUNTAIN GROVE
State	:	MO
Zip	:	65711-1287
Country	:	US
Telephone Number	:	417-926-1770
Fax Number	:	417-926-1785

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	09/21/2016

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