Provider Demographics
NPI:1104802479
Name:CRAVENS, WILLIAM P (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:P
Last Name:CRAVENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6067
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MO
Mailing Address - Zip Code:65251-6067
Mailing Address - Country:US
Mailing Address - Phone:573-592-0337
Mailing Address - Fax:573-592-0711
Practice Address - Street 1:850 WEST HOSPITAL DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251
Practice Address - Country:US
Practice Address - Phone:573-592-0337
Practice Address - Fax:573-592-0711
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR7F41207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA11608Medicare UPIN
MO000005870Medicare ID - Type Unspecified