MEDICARE: JEFFREY L CRAVER 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	R5A28	MO
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	036-060815	IL
3	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	C4174	KY

General Provider Information

NPI Number	:	1629035886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY L CRAVER MD

Provider Business Mailing Address
First Line	:	1402 S GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-1004
Country	:	US
Telephone Number	:	314-768-8803
Fax Number	:	314-977-7615

Provider Business Practice Location Address
First Line	:	1402 S GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-1004
Country	:	US
Telephone Number	:	314-768-8803
Fax Number	:	314-977-7615

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	08/26/2025

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Directions to “ JEFFREY L CRAVER MD” Practice Location

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