Provider Demographics
NPI:1043783566
Name:J. DAVID CRANOR MD LLC
Entity Type:Organization
Organization Name:J. DAVID CRANOR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CRANOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-232-4505
Mailing Address - Street 1:2105 BIGHORN DR.
Mailing Address - Street 2:#102
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-9166
Mailing Address - Country:US
Mailing Address - Phone:970-226-6000
Mailing Address - Fax:970-226-6007
Practice Address - Street 1:2105 BIGHORN DR.
Practice Address - Street 2:#102
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-9166
Practice Address - Country:US
Practice Address - Phone:970-226-6000
Practice Address - Fax:970-226-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-08
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1962516328Medicaid