Provider Demographics
NPI:1942319611
Name:CROWE, TALMADGE LAYNE (MD)
Entity Type:Individual
Prefix:
First Name:TALMADGE
Middle Name:LAYNE
Last Name:CROWE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LAYNE
Other - Middle Name:T
Other - Last Name:CROWE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9150 JEWEL LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-5381
Mailing Address - Country:US
Mailing Address - Phone:907-248-8561
Mailing Address - Fax:907-248-8563
Practice Address - Street 1:9150 JEWEL LAKE RD
Practice Address - Street 2:SUITE B
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-5381
Practice Address - Country:US
Practice Address - Phone:907-333-8561
Practice Address - Fax:907-333-8560
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3449207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD17721Medicaid
AKK161690Medicare PIN
AKK152595Medicare PIN