Provider Demographics
NPI:1174665970
Name:CROW, SAMUEL A II (DO)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:A
Last Name:CROW
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:1640 E KEARNEY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4106
Practice Address - Country:US
Practice Address - Phone:417-863-9190
Practice Address - Fax:417-863-9073
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO100282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO81931OtherAR BLUE SHIELD #
MO243377207Medicaid
MO243377207Medicaid
MOF26606Medicare UPIN