Provider Demographics
NPI:1356577134
Name:CROWE, CLARENCE EDWARD II (CPO)
Entity type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:EDWARD
Last Name:CROWE
Suffix:II
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5640 N GALLOWAY RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2704
Mailing Address - Country:US
Mailing Address - Phone:863-581-5833
Mailing Address - Fax:
Practice Address - Street 1:1705 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3001
Practice Address - Country:US
Practice Address - Phone:863-853-1833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-07
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPRO60, ORF 16174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist