Provider Demographics
NPI:1790911378
Name:CROWE, EDWARD H (IDMT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:H
Last Name:CROWE
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BARTLEY ST
Mailing Address - Street 2:HQ AFSOC/SGX
Mailing Address - City:HURLBURT FIELD
Mailing Address - State:FL
Mailing Address - Zip Code:32544-5328
Mailing Address - Country:US
Mailing Address - Phone:850-884-2276
Mailing Address - Fax:
Practice Address - Street 1:100 BARTLEY ST
Practice Address - Street 2:HQ AFSOC/SGX
Practice Address - City:HURLBURT FIELD
Practice Address - State:FL
Practice Address - Zip Code:32544-5328
Practice Address - Country:US
Practice Address - Phone:850-884-2276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians