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DR. DOUGLAS A CRASE MD

>> Family Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1295115236

Individual Registrant:
DR. DOUGLAS A CRASE MD
Gender: M
Not Sole Proprietor

Location and contact information for practice:
233 S MAIN ST  LICKING, MO 65542 US
Tel: 573-674-3011  Fax: 573-674-4765

Contact information for business:
PO BOX 47  LICKING, MO 65542-0047 US
Tel: 573-674-3011  Fax: 573-674-4765

Registration Information:
NPI: 1295115236
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N207Q00000XAllopathic & Osteopathic Physicians
Family Medicine
KS94-08586
N208M00000XAllopathic & Osteopathic Physicians
Hospitalist
KS04-39253
Y207Q00000XAllopathic & Osteopathic Physicians
Family Medicine
MO2018005000

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
200052063MO05
CLIA26D0679044MO01
KANSAS MEDICAL LICENSE04-39253KS01
MEDICARE PART B132450013MO01
MEDICARE PART B501010023MO01




HEALTH CARE JOBS MO - Page 1



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