Provider Demographics
NPI:1750472403
Name:CRANE, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
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 1:105 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3919
Mailing Address - Country:US
Mailing Address - Phone:307-332-5886
Mailing Address - Fax:307-332-4276
Practice Address - Street 1:105 WYOMING ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3391
Practice Address - Country:US
Practice Address - Phone:307-332-5886
Practice Address - Fax:307-332-4276
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2367A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B42858Medicare UPIN
WYW301376Medicare PIN