Provider Demographics
NPI:1760649388
Name:CRABTREE, DONALD (DO)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:CRABTREE
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 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-651-0018
Mailing Address - Fax:501-463-6326
Practice Address - Street 1:117 PIPER ST STE L
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8263
Practice Address - Country:US
Practice Address - Phone:501-651-0018
Practice Address - Fax:501-463-6326
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-8972207LC0200X, 208VP0000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR199401003Medicaid
MO431560263OtherTRICARE
MO132300316Medicare PIN
MO132680427Medicare PIN
AR199401003Medicaid
MOP01229171OtherRR MCR
MO1760649388Medicaid