Provider Demographics
NPI:1205175569
Name:CRATTY, LAWRENCE R JR (RDCS)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:R
Last Name:CRATTY
Suffix:JR
Gender:M
Credentials:RDCS
Other - Prefix:MR
Other - First Name:LARRY
Other - Middle Name:R
Other - Last Name:CRATTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDCS
Mailing Address - Street 1:3203 E 35TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50317-6936
Mailing Address - Country:US
Mailing Address - Phone:515-262-0869
Mailing Address - Fax:
Practice Address - Street 1:3600 30TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-5753
Practice Address - Country:US
Practice Address - Phone:515-699-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA134920246W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Cardiology