Provider Demographics
NPI:1801865324
Name:CROWDER, BRENDA JANE (MD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JANE
Last Name:CROWDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 W ELK AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2654
Mailing Address - Country:US
Mailing Address - Phone:423-543-2584
Mailing Address - Fax:423-722-2060
Practice Address - Street 1:1500 W ELK AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2654
Practice Address - Country:US
Practice Address - Phone:423-543-2584
Practice Address - Fax:423-722-2060
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD17907207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN160055035OtherRAILROAD MEDICARE
TN0327017Medicaid
TNTN0101OtherJOHN DEERE COMMERICAL INS
TN3131685OtherBCBS OF TENNESSEE
TNTN0101OtherJOHN DEERE COMMERICAL INS
TN3131685OtherBCBS OF TENNESSEE
TN2178946OtherCIGNA
TN3027010Medicare PIN