Provider Demographics
NPI:1821329442
Name:CHARLES R. CRANE, M.D. AND ASSOCIATES
Entity Type:Organization
Organization Name:CHARLES R. CRANE, M.D. AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-343-6772
Mailing Address - Street 1:PO BOX 550337
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75355-0337
Mailing Address - Country:US
Mailing Address - Phone:214-343-6772
Mailing Address - Fax:214-343-6686
Practice Address - Street 1:7920 BELT LINE RD STE 120
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-8148
Practice Address - Country:US
Practice Address - Phone:214-343-6772
Practice Address - Fax:214-343-6686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1594174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0356347-01Medicaid