Healthcare Provider Details

I. General information

NPI: 1972761021
Provider Name (Legal Business Name): CHRISTOPHER CROWE NAVY IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC BOX 8023
APO AA
28533-0023
US

IV. Provider business mailing address

BUILDING 4389 BEAUFORT ROAD
CHERRY POINT NC
28533
US

V. Phone/Fax

Practice location:
  • Phone: 252-466-0505
  • Fax:
Mailing address:
  • Phone: 252-466-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: