MEDICARE: DR. KENNETH L CRAWFORD M.D.

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	208600000X	Surgery Physician	17107	OK

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

General Provider Information

NPI Number	:	1801820402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH L CRAWFORD M.D.

Provider Business Mailing Address
First Line	:	10525 HIGHVIEW DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73151-9374
Country	:	US
Telephone Number	:	405-755-0220
Fax Number	:	405-755-9203

Provider Business Practice Location Address
First Line	:	10525 HIGHVIEW DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73151-9374
Country	:	US
Telephone Number	:	405-755-0220
Fax Number	:	405-755-9203

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	05/20/2014

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