Provider Demographics
NPI:1114139334
Name:CRAWFORD, DEBRA ANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:ANNE
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 1:4202 SW LEE BLVD
Mailing Address - Street 2:BLDG B, SUITE A
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-8300
Mailing Address - Country:US
Mailing Address - Phone:580-699-8020
Mailing Address - Fax:580-699-8060
Practice Address - Street 1:4202 SW LEE BLVD
Practice Address - Street 2:BLDG B, SUITE A
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-8300
Practice Address - Country:US
Practice Address - Phone:580-699-8020
Practice Address - Fax:580-699-8060
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4396207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200275250AMedicaid