Healthcare Provider Details

I. General information

NPI: 1114988086
Provider Name (Legal Business Name): JASON BRADLEY CROWDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14245 DEDEAUX RD
GULFPORT MS
39503-3369
US

IV. Provider business mailing address

PO BOX 604
BILOXI MS
39533-0604
US

V. Phone/Fax

Practice location:
  • Phone: 228-314-7226
  • Fax: 228-314-7227
Mailing address:
  • Phone: 251-591-9769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number00026357
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number00026357
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberME144489
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number00026357
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME144489
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: