Provider Demographics
NPI:1437138856
Name:CRAWFORD, RICKY E (MD)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:E
Last Name:CRAWFORD
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 1:1202 W BUENA VISTA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710
Mailing Address - Country:US
Mailing Address - Phone:812-429-1520
Mailing Address - Fax:812-429-1523
Practice Address - Street 1:1202 W BUENA VISTA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710
Practice Address - Country:US
Practice Address - Phone:812-429-1520
Practice Address - Fax:812-429-1523
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031897207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100246550AMedicaid
C25864Medicare UPIN
IN100246550AMedicaid