Provider Demographics
NPI:1942564653
Name:DOUGLAS CROWLEY MD, INC
Entity Type:Organization
Organization Name:DOUGLAS CROWLEY MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ SOLE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-815-7064
Mailing Address - Street 1:940 BLUEJACK RD
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4061
Mailing Address - Country:US
Mailing Address - Phone:760-815-7064
Mailing Address - Fax:
Practice Address - Street 1:3863 CLAIREMONT DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5831
Practice Address - Country:US
Practice Address - Phone:858-500-2693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107750314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility