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General NPI Number Information
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NPI Number | 1629169974
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Entity Type | Individual
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Provider Name | JOHN EVERETT CREWS III M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 08/25/2014
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Provider Practice Location Address
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Address Line | 655 W PARK LN SUITE 655
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City | PHILADELPHIA
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State | PA
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Zip | 19144-3712
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Country | US
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Telephone | 267-573-9705
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Fax | 215-531-8066
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Provider Business Mailing Address
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Address Line | 655 W PARK LN SUITE 655
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City | PHILADELPHIA
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State | PA
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Zip | 19144-3712
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Country | US
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Telephone | 267-573-9705
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Fax | 215-531-8066
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD431004
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License Number State | PA
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