Provider Demographics
NPI:1063259950
Name:CRANE, ALEX (PA)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:CRANE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2393 E HIGHWAY MM
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65010-9183
Mailing Address - Country:US
Mailing Address - Phone:660-422-1686
Mailing Address - Fax:
Practice Address - Street 1:2393 E HIGHWAY MM
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MO
Practice Address - Zip Code:65010-9183
Practice Address - Country:US
Practice Address - Phone:660-422-1686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant