Provider Demographics
NPI:1285689687
Name:CROWDER, SARA E (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:CROWDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:1605 E BROADWAY
Mailing Address - Street 2:BROADWAY MEDICAL PLAZA 2, SUITE 260
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8023
Mailing Address - Country:US
Mailing Address - Phone:573-442-2221
Mailing Address - Fax:573-449-8646
Practice Address - Street 1:1605 E BROADWAY
Practice Address - Street 2:BROADWAY MEDICAL PLAZA 2, SUITE 260
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8023
Practice Address - Country:US
Practice Address - Phone:573-442-2221
Practice Address - Fax:573-449-8646
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2002015736207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205887904Medicaid
MO032011938Medicare ID - Type Unspecified
H01062Medicare UPIN