Provider Demographics
NPI:1104867514
Name:CROWL, PAUL WALTER (PA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:WALTER
Last Name:CROWL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 E CENTRAL BLVD
Mailing Address - Street 2:
Mailing Address - City:ANADARKO
Mailing Address - State:OK
Mailing Address - Zip Code:73005-4405
Mailing Address - Country:US
Mailing Address - Phone:405-247-2551
Mailing Address - Fax:405-247-8258
Practice Address - Street 1:1002 E CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005-4405
Practice Address - Country:US
Practice Address - Phone:405-247-2551
Practice Address - Fax:405-247-8258
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1006363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK290248YQ3WMedicare PIN