Healthcare Provider Details

I. General information

NPI: 1861951675
Provider Name (Legal Business Name): MATTHEW TANNER CRABTREE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 WESTEN ST
BOWLING GREEN KY
42104-4152
US

IV. Provider business mailing address

1850 WESTEN ST
BOWLING GREEN KY
42104-4152
US

V. Phone/Fax

Practice location:
  • Phone: 270-467-9000
  • Fax: 833-455-6571
Mailing address:
  • Phone: 270-467-9000
  • Fax: 833-455-6571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number06290
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: