Healthcare Provider Details

I. General information

NPI: 1962074955
Provider Name (Legal Business Name): GABRIEL MARCUS CROW DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2021
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W 17TH ST
TULSA OK
74107-1886
US

IV. Provider business mailing address

1 JARRETT WHITE RD ATTN: DEPARTMENT OF PSYCHIATRY
TRIPLER AMC HI
96859
US

V. Phone/Fax

Practice location:
  • Phone: 918-582-1972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2024006478
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: