Provider Demographics
NPI:1376719351
Name:DAVID L. CROWDER MD, INC
Entity Type:Organization
Organization Name:DAVID L. CROWDER MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CROWDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-736-1405
Mailing Address - Street 1:1985 AL HIGHWAY 157
Mailing Address - Street 2:SUITE B
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-0692
Mailing Address - Country:US
Mailing Address - Phone:256-736-1405
Mailing Address - Fax:256-737-7255
Practice Address - Street 1:1985 AL HIGHWAY 157
Practice Address - Street 2:SUITE B
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0692
Practice Address - Country:US
Practice Address - Phone:256-736-1405
Practice Address - Fax:256-737-7255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALJ663Medicare PIN