Individual
DR. JERRY C CRAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1205 W MAIN ST, COLLINSVILLE, OK 74021-3114
(918) 371-5885
(918) 371-0584
Mailing address
1205 W MAIN ST, COLLINSVILLE, OK 74021-3114
(918) 371-5885
(918) 371-0584
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1867
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080114764
PALMETTO GBA-RAILROAD
OK
05
—
200305570A
—
OK
01
—
731479816
TRICARE
OK
01
—
731479816001
BLUE CROSS BLUE SHIELD
OK
Enumeration date
11/10/2005
Last updated
04/23/2012
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