Provider Demographics
NPI:1548266737
Name:CRAWFORD, STEVEN (DO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:CRAWFORD
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 1:12 JEFFERSON SQ
Mailing Address - Street 2:
Mailing Address - City:DE SOTO
Mailing Address - State:MO
Mailing Address - Zip Code:63020-1031
Mailing Address - Country:US
Mailing Address - Phone:636-586-6685
Mailing Address - Fax:636-586-2780
Practice Address - Street 1:12 JEFFERSON SQ
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:MO
Practice Address - Zip Code:63020-1031
Practice Address - Country:US
Practice Address - Phone:636-586-6685
Practice Address - Fax:636-586-2780
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2022-02-28
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-05-16
Provider Licenses
StateLicense IDTaxonomies
MOR6C68207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2640OtherPART B MEDICARE
MO598201408Medicaid
MO2640OtherPART B MEDICARE
MO263849Medicare ID - Type Unspecified
MO598201408Medicaid