Provider Demographics
NPI:1053476135
Name:CROWLEY, JOHN DALE (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DALE
Last Name:CROWLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 HUNTERS GLEN RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-5008
Mailing Address - Country:US
Mailing Address - Phone:325-949-5722
Mailing Address - Fax:325-947-2054
Practice Address - Street 1:1636 HUNTERS GLEN RD
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-5008
Practice Address - Country:US
Practice Address - Phone:325-949-5722
Practice Address - Fax:325-947-2054
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH71332084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry