MEDICARE: KENNETH L. CRAWFORD,M.D.PLLC

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	2086S0102X	Surgical Critical Care Physician	17107	OR

General Provider Information

NPI Number	:	1881882181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNETH L. CRAWFORD,M.D.PLLC

Provider Business Mailing Address
First Line	:	4200 W MEMORIAL RD
Second Line	:	SUITE # 405
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-9350
Country	:	US
Telephone Number	:	405-755-0220
Fax Number	:

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	:

Authorized Official
Title or Position	:	SURGEON
Name	:	KENNETH L. CRAWFORD
Credential	:	M.D.
Telephone Number	:	405-755-0220

Provider Enumeration Date	:	10/11/2007
Last Update Date	:	06/29/2010

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