Healthcare Provider Details
I. General information
NPI: 1437976271
Provider Name (Legal Business Name): CROWLEY MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/23/2024
Last Update Date: 01/08/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1030 W 25TH STREET SUITE H
YUMA AZ
85364-8384
US
IV. Provider business mailing address
PO BOX 5870
MESA AZ
85211-5870
US
V. Phone/Fax
- Phone: 928-210-9165
- Fax: 480-874-7015
- Phone: 480-874-7014
- Fax: 480-874-7015
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207L00000X |
| Taxonomy | Anesthesiology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
JOHN
W
CROWLEY
Title or Position: OWNER
Credential: DO
Phone: 480-874-7013