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General NPI Number Information
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NPI Number | 1639197494
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Entity Type | Individual
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Provider Name | MARSHALL J CROWTHER M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 12/15/2014
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Provider Practice Location Address
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Address Line | 400 REBEL DRIVE
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City | UNIVERSITY
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State | MS
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Zip | 38677
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Country | US
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Telephone | 662-915-7274
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1848 400 REBEL DRIVE
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City | UNIVERSITY
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State | MS
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Zip | 38677-1848
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Country | US
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Telephone | 662-915-7274
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 27417
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 24443
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 2080S0010X
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Taxonomy Name | Pediatric Sports Medicine Physician
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License Number | 23389
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License Number State | MS
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