Provider Demographics
NPI:1164725453
Name:CROW, ANTHONY J
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:J
Last Name:CROW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18917 FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-7957
Mailing Address - Country:US
Mailing Address - Phone:218-396-0353
Mailing Address - Fax:
Practice Address - Street 1:18917 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-7957
Practice Address - Country:US
Practice Address - Phone:218-396-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor