MEDICARE: KATHLEEN CROWLEY MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	G4942	TX
2	207RH0003X	Hematology & Oncology Physician	G4942	TX

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00312848	OTHER	TX	RAILROAD MEDICARE PIN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8B5599	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1063428126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN CROWLEY MD

Provider Business Mailing Address
First Line	:	200 W MAGNOLIA AVE STE 201
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-7657
Country	:	US
Telephone Number	:	817-702-2977
Fax Number	:	817-702-2140

Provider Business Practice Location Address
First Line	:	1201 S MAIN ST FL 4
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4804
Country	:	US
Telephone Number	:	817-702-6500
Fax Number	:	817-702-6561

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	09/07/2022

1223 S MAIN ST
FORT WORTH, TX
76104-4804

Practice Phone: 817-702-7314
Practice Fax: 817-702-7315