Provider Demographics
NPI:1225244981
Name:CRANE, STEPHEN MCKINNE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MCKINNE
Last Name:CRANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 DOYLE PARK DR
Mailing Address - Street 2:SUITE G-04
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4558
Mailing Address - Country:US
Mailing Address - Phone:707-303-8360
Mailing Address - Fax:707-303-8361
Practice Address - Street 1:500 DOYLE PARK DR
Practice Address - Street 2:SUITE G-04
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4558
Practice Address - Country:US
Practice Address - Phone:707-303-8360
Practice Address - Fax:707-303-8361
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC43300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC043300OtherCA MEDICAL LICENSE #
BC1045497OtherDEA NUMBER
BC1045497OtherDEA NUMBER
CAD00765Medicare UPIN
CA530-743-1587Medicare ID - Type Unspecified
CACA121987Medicare PIN