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General NPI Number Information
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NPI Number | 1013102656
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Entity Type | Organization
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Legal Business Name | KENNETH J CROWE MD
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 802 N MAIN ST SUITE A
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City | OPP
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State | AL
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Zip | 36467-1614
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Country | US
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Telephone | 334-493-2530
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Fax | 334-493-3973
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Provider Business Mailing Address
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Address Line | 802 N MAIN ST SUITE A
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City | OPP
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State | AL
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Zip | 36467-1614
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Country | US
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Telephone | 334-493-2530
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Fax | 334-493-3973
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | MRS. TERRY C CROWE
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Credential |
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Telephone | 334-493-2530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 18485
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License Number State | AL
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