Provider Demographics
NPI:1295729085
Name:CROWNOVER, BRIAN KEITH (MD, FAAFP)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KEITH
Last Name:CROWNOVER
Suffix:
Gender:M
Credentials:MD, FAAFP
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Mailing Address - Street 1:2428 N STOKESBERRY PL
Mailing Address - Street 2:TREASURE VALLEY FAMILY MEDICINE
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5035
Mailing Address - Country:US
Mailing Address - Phone:208-895-0050
Mailing Address - Fax:208-887-0033
Practice Address - Street 1:2428 N STOKESBERRY PL
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5035
Practice Address - Country:US
Practice Address - Phone:208-895-0050
Practice Address - Fax:855-543-3086
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM11819207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
20006018Medicare PIN
20005558Medicare PIN