Basic Information
| Provider Information | |||||||||
| NPI: | 1114139334 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRAWFORD | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4202 SW LEE BLVD | ||||||||
| Address2: | BLDG B, SUITE A | ||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735058300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5806998020 | ||||||||
| FaxNumber: | 5806998060 | ||||||||
| Practice Location | |||||||||
| Address1: | 4202 SW LEE BLVD | ||||||||
| Address2: | BLDG B, SUITE A | ||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735058300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5806998020 | ||||||||
| FaxNumber: | 5806998060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 01/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VH0002X | 4396 | OK | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200275250A | 05 | OK | MEDICAID |