Healthcare Provider Details

I. General information

NPI: 1336582659
Provider Name (Legal Business Name): MATTHEW JOHN CROWE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SAINT MICHAELS DR STE 117
SANTA FE NM
87505-7621
US

IV. Provider business mailing address

465 SAINT MICHAELS DR STE 117
SANTA FE NM
87505-7621
US

V. Phone/Fax

Practice location:
  • Phone: 505-984-2600
  • Fax:
Mailing address:
  • Phone: 505-984-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberQ3350
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberQ3350
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number010974
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberQ3350
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberDO2022-0069
License Number StateNM
# 6
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberDO2022-0069
License Number StateNM
# 7
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10047254
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: