Provider Demographics
NPI:1740391473
Name:CRAWFORD, MARK L (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:CRAWFORD
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 1:1333 LONE OAK RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-5092
Mailing Address - Country:US
Mailing Address - Phone:270-415-9970
Mailing Address - Fax:270-415-9976
Practice Address - Street 1:1333 LONE OAK RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-5092
Practice Address - Country:US
Practice Address - Phone:270-415-9970
Practice Address - Fax:270-415-9976
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22858207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64228588Medicaid
KY200014204OtherRAILROAD MEDICARE
KY64228588Medicaid