Healthcare Provider Details

I. General information

NPI: 1073500278
Provider Name (Legal Business Name): JEFFREY J CROWLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 COMMERCE DR SUITE 101
BAKERSFIELD CA
93309-0411
US

IV. Provider business mailing address

5101 COMMERCE DR SUITE 101
BAKERSFIELD CA
93309-0411
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-3756
  • Fax: 661-327-2332
Mailing address:
  • Phone: 661-327-3756
  • Fax: 661-327-2332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberG77643
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License NumberG77643
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG77643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: