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NPI Code Detail

MEDICARE: DR. JOHN WALTON CROWDER D.D.S.

MEDICARE: DR. JOHN WALTON CROWDER D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223S0112XOral and Maxillofacial Surgery (Dentist)DDS 4312TN

General Provider Information

NPI Number : 1497732861
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN WALTON CROWDER D.D.S.
Provider Business Mailing Address
First Line : 39 MURRAY GUARD DR
Second Line :
City : JACKSON
State : TN
Zip : 38305-3610
Country : US
Telephone Number : 731-660-7799
Fax Number :
Provider Business Practice Location Address
First Line : 39 MURRAY GUARD DR
Second Line :
City : JACKSON
State : TN
Zip : 38305-3610
Country : US
Telephone Number : 731-660-7799
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2005
Last Update Date : 08/05/2016

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