Provider Demographics
NPI:1326014291
Name:CRAVEN, PAUL WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:WILLIAM
Last Name:CRAVEN
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 1:4859 DOVER CENTER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3184
Mailing Address - Country:US
Mailing Address - Phone:440-734-4090
Mailing Address - Fax:440-734-2231
Practice Address - Street 1:4859 DOVER CENTER RD
Practice Address - Street 2:#7
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3184
Practice Address - Country:US
Practice Address - Phone:440-734-4090
Practice Address - Fax:440-734-2231
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046184207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0561404Medicaid
OH0562934Medicare ID - Type Unspecified
OH0561404Medicaid