Provider Demographics
NPI:1649250002
Name:CRAIN, DWAIN G (DO)
Entity type:Individual
Prefix:DR
First Name:DWAIN
Middle Name:G
Last Name:CRAIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AYR
Mailing Address - State:IA
Mailing Address - Zip Code:50854-1635
Mailing Address - Country:US
Mailing Address - Phone:641-464-3911
Mailing Address - Fax:641-464-2939
Practice Address - Street 1:207 N TAYLOR ST
Practice Address - Street 2:
Practice Address - City:MOUNT AYR
Practice Address - State:IA
Practice Address - Zip Code:50854-1635
Practice Address - Country:US
Practice Address - Phone:641-464-3911
Practice Address - Fax:641-464-2939
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0226704Medicaid
IAI7596Medicare ID - Type UnspecifiedMEDICARE GROUP ID
IAD46553Medicare UPIN