Provider Demographics
NPI:1295115236
Name:CRASE, DOUGLAS A (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:A
Last Name:CRASE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DOUGLAS
Other - Middle Name:A
Other - Last Name:CRASE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:805 N KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-2022
Mailing Address - Country:US
Mailing Address - Phone:417-256-2111
Mailing Address - Fax:
Practice Address - Street 1:805 N KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2022
Practice Address - Country:US
Practice Address - Phone:417-256-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-08586207Q00000X
KS04-39253208M00000X
MO2018005000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO501010023OtherMEDICARE PART B
MO200052063Medicaid
MO26D0679044OtherCLIA
KS04-39253OtherKANSAS MEDICAL LICENSE
MO132450013OtherMEDICARE PART B