Provider Demographics
NPI:1467428839
Name:CRANE, JOHN B (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:CRANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1780 OLD HIGHWAY 50 E
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-3397
Mailing Address - Country:US
Mailing Address - Phone:636-582-8100
Mailing Address - Fax:636-583-2885
Practice Address - Street 1:1800 COMMUNITY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-8804
Practice Address - Country:US
Practice Address - Phone:660-885-8131
Practice Address - Fax:660-885-3690
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO296242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO177912OtherBLUE CROSS BLUE SHIELD
MO200481240Medicaid
MO200481240Medicaid
MO9683Medicare ID - Type Unspecified