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NPI Code Detail

MEDICARE: BRENDA JANE CROWDER M.D.

MEDICARE: BRENDA JANE CROWDER M.D.
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
1207VG0400XGynecology PhysicianMD17907TN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1160055035OTHERTNRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3TN0101OTHERTNJOHN DEERE COMMERICAL INS
43131685OTHERTNBCBS OF TENNESSEE

General Provider Information

NPI Number : 1801865324
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENDA JANE CROWDER M.D.
Provider Business Mailing Address
First Line : 1500 W ELK AVE
Second Line :
City : ELIZABETHTON
State : TN
Zip : 37643-2654
Country : US
Telephone Number : 423-543-2584
Fax Number : 423-722-2060
Provider Business Practice Location Address
First Line : 1500 W ELK AVE
Second Line :
City : ELIZABETHTON
State : TN
Zip : 37643-2654
Country : US
Telephone Number : 423-543-2584
Fax Number : 423-722-2060
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2006
Last Update Date : 04/29/2021

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