Provider Demographics
NPI:1841345881
Name:CRANFORD, ALTON (PA)
Entity type:Individual
Prefix:
First Name:ALTON
Middle Name:
Last Name:CRANFORD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 PARKLAWN DR
Mailing Address - Street 2:SUE 2
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4215
Mailing Address - Country:US
Mailing Address - Phone:405-869-0340
Mailing Address - Fax:405-869-0350
Practice Address - Street 1:2816 PARKLAWN DR
Practice Address - Street 2:SUE 2
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4215
Practice Address - Country:US
Practice Address - Phone:405-869-0340
Practice Address - Fax:405-869-0350
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA522363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
243604704Medicare ID - Type Unspecified