Provider Demographics
NPI:1801830955
Name:CRAWFORD, WILLIAM L (PA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:PA
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 1076
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-5076
Mailing Address - Country:US
Mailing Address - Phone:606-783-6500
Mailing Address - Fax:606-783-6904
Practice Address - Street 1:222 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1179
Practice Address - Country:US
Practice Address - Phone:606-783-6500
Practice Address - Fax:606-783-6904
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK869363A00000X
KYPA2084363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10059120OtherAMERIGROUP
GA811502707AMedicaid
GA811502707BMedicaid
GA811502707CMedicaid
GA811502707DMedicaid
GA10059120OtherAMERIGROUP
GAP00141103Medicare PIN
GA811502707AMedicaid
GA97WCFMQMedicare PIN