Provider Demographics
NPI:1114988086
Name:CROWDER, JASON BRADLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:BRADLEY
Last Name:CROWDER
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 1:2478 PROVENCE PL
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2291
Mailing Address - Country:US
Mailing Address - Phone:251-591-9769
Mailing Address - Fax:
Practice Address - Street 1:14245 DEDEAUX RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3369
Practice Address - Country:US
Practice Address - Phone:228-314-7226
Practice Address - Fax:228-314-7227
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000263572085R0202X, 2085R0204X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice