Provider Demographics
NPI:1265566392
Name:CRANE, BENJAMIN P (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:P
Last Name:CRANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14825 NORTH OUTER 40 ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2154
Mailing Address - Country:US
Mailing Address - Phone:314-336-2555
Mailing Address - Fax:314-336-2557
Practice Address - Street 1:14825 NORTH OUTER 40 ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2154
Practice Address - Country:US
Practice Address - Phone:314-336-2555
Practice Address - Fax:314-336-2557
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40975207XS0117X
MO2008002402207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1871542761Medicaid
MO0OtherHEALTHLINK
MO1265566392AAOtherESSENCE HEALTHCARE
MO928550OtherHEALTHLINK
MO0OtherBLUE CROSS BLUE SHILED