Healthcare Provider Details

I. General information

NPI: 1790774958
Provider Name (Legal Business Name): ROBERT FRANKLIN CROWE M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 S 10TH ST SUITE C
LEESVILLE LA
71446-4659
US

IV. Provider business mailing address

802 S 10TH ST SUITE C
LEESVILLE LA
71446-4659
US

V. Phone/Fax

Practice location:
  • Phone: 337-239-2207
  • Fax: 337-239-2583
Mailing address:
  • Phone: 337-239-2207
  • Fax: 337-239-2583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200653
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: