Provider Demographics
NPI:1003995176
Name:CRUTCHFIELD, DOUGLAS ALAN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:ALAN
Last Name:CRUTCHFIELD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 5 BOX 114
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:OK
Mailing Address - Zip Code:74432-9501
Mailing Address - Country:US
Mailing Address - Phone:918-339-4122
Mailing Address - Fax:
Practice Address - Street 1:RR 5 BOX 114
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-9501
Practice Address - Country:US
Practice Address - Phone:918-339-4122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29347367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered