Provider Demographics
NPI:1366559973
Name:ALEXANDER, THOMAS CRAWFORD (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CRAWFORD
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 S BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-6310
Mailing Address - Country:US
Mailing Address - Phone:918-756-5471
Mailing Address - Fax:918-756-5498
Practice Address - Street 1:1212 S BELMONT AVE
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6310
Practice Address - Country:US
Practice Address - Phone:918-756-5471
Practice Address - Fax:918-756-5498
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8128207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK50657OtherBLUE LINCS PROVIDER
OK0060321OtherUNITED MINE WORKERS
OK100109390AMedicaid
OK112859759OtherRAILROAD MEDICARE
OK730937006OtherEIN NUMBER
OKD38600Medicare UPIN
OK0060321OtherUNITED MINE WORKERS