Provider Demographics
NPI:1184621732
Name:CRANE, MARY ELIZABETH (DPM)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:CRANE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:MARYBETH
Other - Middle Name:
Other - Last Name:CRANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:2421 IRA E WOODS AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3928
Mailing Address - Country:US
Mailing Address - Phone:817-416-6155
Mailing Address - Fax:817-329-9434
Practice Address - Street 1:2421 IRA E WOODS AVE
Practice Address - Street 2:STE 100
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3928
Practice Address - Country:US
Practice Address - Phone:817-416-6155
Practice Address - Fax:817-329-9434
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1379213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A2505OtherBCBS
TX8A2505Medicare ID - Type Unspecified
TXP00043735Medicare PIN
TX8A2505OtherBCBS