Provider Demographics
NPI:1407898083
Name:CROWELL, BERNARD (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:
Last Name:CROWELL
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:PO BOX 242664
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-0029
Mailing Address - Country:US
Mailing Address - Phone:501-975-1916
Mailing Address - Fax:501-975-1917
Practice Address - Street 1:13100 CHENAL PKWY
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-5214
Practice Address - Country:US
Practice Address - Phone:501-975-1916
Practice Address - Fax:501-975-1917
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4267207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR155541001Medicaid
AR5N082OtherBLUE CROSS BLUE SHIELD
201934005OtherTRICARE
9624653OtherCIGNA
P00211088OtherRAILROAD MEDICARE