Provider Demographics
NPI:1811978281
Name:CRANE, JOHN T (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
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 1:1900 BOISE AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-5004
Mailing Address - Country:US
Mailing Address - Phone:970-820-2610
Mailing Address - Fax:970-820-2611
Practice Address - Street 1:1900 BOISE AVE STE 410
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5004
Practice Address - Country:US
Practice Address - Phone:970-820-2610
Practice Address - Fax:970-820-2611
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33354207VF0040X
CODR.0033354207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01333541Medicaid
WY117620000Medicaid
COCR99314OtherANTHEM BCBS
COCR99314OtherANTHEM BCBS
CO01333541Medicaid
NE$$$$$$$$$Medicaid
COC552298Medicare PIN