Provider Demographics
NPI:1639197494
Name:CROWTHER, MARSHALL J (MD)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:J
Last Name:CROWTHER
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 1848
Mailing Address - Street 2:400 REBEL DRIVE
Mailing Address - City:UNIVERSITY
Mailing Address - State:MS
Mailing Address - Zip Code:38677-1848
Mailing Address - Country:US
Mailing Address - Phone:662-915-7274
Mailing Address - Fax:
Practice Address - Street 1:400 REBEL DRIVE
Practice Address - Street 2:
Practice Address - City:UNIVERSITY
Practice Address - State:MS
Practice Address - Zip Code:38677
Practice Address - Country:US
Practice Address - Phone:662-915-7274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27417207X00000X
SC24443208000000X
MS233892080S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL104966Medicaid
AL051593910OtherBCBS
AL114548Medicaid
ALP00799667OtherRAILROAD MEDICARE
AL125307Medicaid
AL51100240OtherBCBS
AL51113111OtherBCBS
AL114548Medicaid