Provider Demographics
NPI:1639147689
Name:KROW, GEORGE LEO JR (IDC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:LEO
Last Name:KROW
Suffix:JR
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:104 LANCE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-8640
Mailing Address - Country:US
Mailing Address - Phone:910-989-1075
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL CAMP LEJEUNE
Practice Address - Street 2:100 BREWSTER BLVD
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542-2538
Practice Address - Country:US
Practice Address - Phone:910-451-1053
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman