Provider Demographics
NPI:1689650673
Name:CRANE, DOUGLAS GORDON (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:GORDON
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:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:COQUILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97423-0194
Mailing Address - Country:US
Mailing Address - Phone:541-329-0144
Mailing Address - Fax:541-329-0143
Practice Address - Street 1:209 N CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:COQUILLE
Practice Address - State:OR
Practice Address - Zip Code:97423-1274
Practice Address - Country:US
Practice Address - Phone:541-329-0144
Practice Address - Fax:541-329-0143
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22263207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0577260001OtherDMERC NUMBER
ORR0000WFBTVOtherGROUP PIN NUMBER
OR110199508OtherRR MEDICARE PTAN NUMBER
ORCD8723OtherRR MEDICARE GROUP NUMBER
OR288488Medicaid
ORG91977Medicare UPIN
OR110199508OtherRR MEDICARE PTAN NUMBER
OR288488Medicaid