Provider Demographics
NPI:1336233584
Name:CROWN, STANLEY J (MD)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:J
Last Name:CROWN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1137 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-4221
Mailing Address - Country:US
Mailing Address - Phone:417-255-8464
Mailing Address - Fax:417-255-9741
Practice Address - Street 1:1905 W 19TH ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GROVE
Practice Address - State:MO
Practice Address - Zip Code:65711-1287
Practice Address - Country:US
Practice Address - Phone:417-926-1770
Practice Address - Fax:417-926-1785
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO104161207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1336233584Medicaid
MO26D2006074OtherCLIA
MO268653Medicare Oscar/Certification
001013872Medicare ID - Type Unspecified
MO1336233584Medicaid
MOMA2517005Medicare PIN