Provider Demographics
NPI:1629055330
Name:CRAWFORD, OLIVER WILSON JR (MD)
Entity Type:Individual
Prefix:
First Name:OLIVER
Middle Name:WILSON
Last Name:CRAWFORD
Suffix:JR
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:PO BOX 863
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36361-0863
Mailing Address - Country:US
Mailing Address - Phone:334-774-5864
Mailing Address - Fax:334-774-1437
Practice Address - Street 1:218 HOSPITAL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-2064
Practice Address - Country:US
Practice Address - Phone:334-774-5864
Practice Address - Fax:334-774-1437
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28100207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL108056Medicaid
AL51048269OtherBCBS
INC25498Medicare UPIN
AL51048269OtherBCBS