Provider Demographics
NPI:1285754747
Name:CRAWFORD, DENNIS
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 VARVERA RD
Mailing Address - Street 2:
Mailing Address - City:DOE RUN
Mailing Address - State:MO
Mailing Address - Zip Code:63637-3121
Mailing Address - Country:US
Mailing Address - Phone:573-756-4656
Mailing Address - Fax:573-760-0532
Practice Address - Street 1:2200 VARVERA RD
Practice Address - Street 2:
Practice Address - City:DOE RUN
Practice Address - State:MO
Practice Address - Zip Code:63637-3121
Practice Address - Country:US
Practice Address - Phone:573-756-4656
Practice Address - Fax:573-760-0532
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0334033747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant