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General NPI Number Information
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NPI Number | 1326169756
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Entity Type | Individual
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Provider Name | KENT L. CROSWELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11811 SAINT CHARLES BLVD
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City | LITTLE ROCK
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State | AR
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Zip | 72211-1644
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Country | US
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Telephone | 501-224-1776
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Fax |
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Provider Business Mailing Address
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Address Line | 11811 SAINT CHARLES BLVD
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City | LITTLE ROCK
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State | AR
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Zip | 72211-1644
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Country | US
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Telephone | 501-224-1776
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202C00000X
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Taxonomy Name | Independent Medical Examiner Physician
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License Number | R3874
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License Number State | AR
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