Provider Demographics
NPI:1043208051
Name:CRAWFORD, MARY J (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E MARION ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:MO
Mailing Address - Zip Code:65275-1041
Mailing Address - Country:US
Mailing Address - Phone:660-327-4911
Mailing Address - Fax:660-327-5501
Practice Address - Street 1:102 E MARION ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:MO
Practice Address - Zip Code:65275-1041
Practice Address - Country:US
Practice Address - Phone:660-327-4911
Practice Address - Fax:660-327-5501
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2J93207Q00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO599120102Medicaid
MO080187042OtherMEDICARE RAIL ROAD
MO242583169Medicaid
MO268910Medicare Oscar/Certification
MO242583169Medicaid
MO000095483Medicare PIN