Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | R4116 | MO |
NPI | 1255359741 |
---|---|
Provider Name | Dr. James P Crane |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63110-1010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 16/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0172070033 | (05) | IL |
200623502 | (05) | MO |
A12373 | (02) |