Provider Demographics
NPI:1023055746
Name:CRAVENS, DAVID D (MD, MSPH, CMD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:CRAVENS
Suffix:
Gender:M
Credentials:MD, MSPH, CMD
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 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:ONE HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-0001
Practice Address - Country:US
Practice Address - Phone:573-884-7733
Practice Address - Fax:573-884-5559
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9438207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200705531Medicaid
MO110803OtherBLUE CHOICE
MO2086329601OtherKANSAS MEDICAID
MO110803OtherBLUE SHIELD
MO122882OtherHEALTHLINK
MO200705531Medicaid
MO122882OtherHEALTHLINK