=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538214804
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFFREY J. CROWLEY, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2007
-----------------------------------------------------
Last Update Date | 05/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5101 COMMERCE DR SUITE 101
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93309-0411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-327-3756
-----------------------------------------------------
Fax | 661-327-2332
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5101 COMMERCE DR SUITE 101
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93309-0411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-327-3756
-----------------------------------------------------
Fax | 661-327-2332
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | DEANNA JACOBS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 661-327-3756
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ND0101X
-----------------------------------------------------
Taxonomy Name | MOHS-Micrographic Surgery Physician
-----------------------------------------------------
License Number | G77643
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207NP0225X
-----------------------------------------------------
Taxonomy Name | Pediatric Dermatology Physician
-----------------------------------------------------
License Number | A70557
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------