MEDICARE: MARSHALL J CROWTHER M.D.

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
1	207X00000X	Orthopaedic Surgery Physician	27417	AL
2	208000000X	Pediatrics Physician	24443	SC
3	2080S0010X	Pediatric Sports Medicine Physician	23389	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00799667	OTHER	AL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	051593910	OTHER	AL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	51100240	OTHER	AL	BCBS
7	51113111	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1639197494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHALL J CROWTHER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1848
Second Line	:	400 REBEL DRIVE
City	:	UNIVERSITY
State	:	MS
Zip	:	38677-1848
Country	:	US
Telephone Number	:	662-915-7274
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 REBEL DRIVE
Second Line	:
City	:	UNIVERSITY
State	:	MS
Zip	:	38677
Country	:	US
Telephone Number	:	662-915-7274
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	12/15/2014

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Directions to “ MARSHALL J CROWTHER M.D.” Practice Location

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