MEDICARE: PHILLIP CROW CCP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	LP8	OK

General Provider Information

NPI Number	:	1558472399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP CROW CCP

Provider Business Mailing Address
First Line	:	3601 N MAY AVE
Second Line	:	SUITE C
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-6641
Country	:	US
Telephone Number	:	405-604-5613
Fax Number	:	405-601-3750

Provider Business Practice Location Address
First Line	:	9110 OAKMONT DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73131-7238
Country	:	US
Telephone Number	:	405-604-5613
Fax Number	:	405-601-3750

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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Directions to “ PHILLIP CROW CCP” Practice Location

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