Provider Demographics
NPI:1851486047
Name:CROWLEY, MEMORY E (DO)
Entity Type:Individual
Prefix:
First Name:MEMORY
Middle Name:E
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:DO
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 121009
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34712
Mailing Address - Country:US
Mailing Address - Phone:352-394-4035
Mailing Address - Fax:352-241-0896
Practice Address - Street 1:1135 LAKE AVE
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:352-394-4035
Practice Address - Fax:352-241-0896
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0S5877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0801105381Medicaid
E72678Medicare UPIN
FL0801105381Medicaid