Provider Demographics
NPI:1003992462
Name:CRABTREE, KENNETH RAY (MD)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:RAY
Last Name:CRABTREE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:GAMALIEL
Mailing Address - State:KY
Mailing Address - Zip Code:42140
Mailing Address - Country:US
Mailing Address - Phone:270-457-3911
Mailing Address - Fax:270-457-3911
Practice Address - Street 1:529 CAPP HARLAN ROAD
Practice Address - Street 2:
Practice Address - City:TOMPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42167
Practice Address - Country:US
Practice Address - Phone:270-487-9231
Practice Address - Fax:270-487-5784
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY13828207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine