Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 2008002402 | MO |
N | 207XS0117X | Orthopaedic Spine Surgeon | 40975 | KY |
NPI | 1265566392 |
---|---|
Provider Name | Benjamin P Crane |
First Address | Saint Louis, MO 63128-2786 |
Second Address | Saint Louis, MO 63128-2786 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 17/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0 | BLUE CROSS BLUE SHILED (01) | MO |
0 | HEALTHLINK (01) | MO |
1265566392AA | ESSENCE HEALTHCARE (01) | MO |
1871542761 | (05) | MO |