MEDICARE: DR. BARRY GLEN CROWE MD

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	22312	AL

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710964739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY GLEN CROWE MD

Provider Business Mailing Address
First Line	:	2000 PEPPERELL PKWY # 4
Second Line	:
City	:	OPELIKA
State	:	AL
Zip	:	36801-5452
Country	:	US
Telephone Number	:	334-528-5959
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 PEPPERELL PKWY
Second Line	:
City	:	OPELIKA
State	:	AL
Zip	:	36801-5452
Country	:	US
Telephone Number	:	334-528-5959
Fax Number	:	334-528-5899

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	06/24/2022

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