Healthcare Provider Details

I. General information

NPI: 1861943540
Provider Name (Legal Business Name): TOMMY CROWLEY III HAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 09/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E KALISTE SALOOM RD STE 206
LAFAYETTE LA
70508-8525
US

IV. Provider business mailing address

110 E KALISTE SALOOM RD STE 206
LAFAYETTE LA
70508-8525
US

V. Phone/Fax

Practice location:
  • Phone: 337-706-8550
  • Fax: 337-706-8559
Mailing address:
  • Phone: 337-706-8550
  • Fax: 337-706-8559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number549
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: