Provider Demographics
NPI:1851577035
Name:SUE E. CROW, M.D.
Entity Type:Organization
Organization Name:SUE E. CROW, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUE
Authorized Official - Middle Name:ELLA
Authorized Official - Last Name:CROW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-739-8717
Mailing Address - Street 1:200 W WINDCREST ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4408
Mailing Address - Country:US
Mailing Address - Phone:830-997-0330
Mailing Address - Fax:830-995-5654
Practice Address - Street 1:815 FRONT STREET
Practice Address - Street 2:
Practice Address - City:COMFORT
Practice Address - State:TX
Practice Address - Zip Code:78013-0156
Practice Address - Country:US
Practice Address - Phone:830-995-5633
Practice Address - Fax:830-995-5654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2321207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00681ROtherBLUE CROSS/BLUE SHIELD
TX00681RMedicare PIN