Provider Demographics
NPI:1942338702
Name:CRANE, JEROME R (PA)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:R
Last Name:CRANE
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 1:707 N WALDRIP ST
Mailing Address - Street 2:
Mailing Address - City:GRAND SALINE
Mailing Address - State:TX
Mailing Address - Zip Code:75140-1555
Mailing Address - Country:US
Mailing Address - Phone:903-913-6300
Mailing Address - Fax:
Practice Address - Street 1:707 N WALDRIP ST
Practice Address - Street 2:
Practice Address - City:GRAND SALINE
Practice Address - State:TX
Practice Address - Zip Code:75140-1555
Practice Address - Country:US
Practice Address - Phone:903-962-4242
Practice Address - Fax:903-962-7799
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01073363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1A3305OtherMEDICARE
TX8561NDOtherBCBS
TX909591OtherMEDICARE
TX307729903Medicaid
TX8MD176OtherBCBS