Provider Demographics
NPI:1659376218
Name:CROWELL, JUDITH ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ELLEN
Last Name:CROWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7800 SW 87TH AVE
Mailing Address - Street 2:STE C300
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3570
Mailing Address - Country:US
Mailing Address - Phone:305-274-0221
Mailing Address - Fax:305-274-7275
Practice Address - Street 1:7800 SW 87TH AVE
Practice Address - Street 2:STE C300
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3570
Practice Address - Country:US
Practice Address - Phone:305-274-0221
Practice Address - Fax:305-274-7275
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 59519207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374646100Medicaid
FLF10349Medicare UPIN
FL14452YMedicare ID - Type Unspecified