Provider Demographics
NPI:1831164342
Name:CROWDER, AMY RUTH (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:RUTH
Last Name:CROWDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-3735
Mailing Address - Country:US
Mailing Address - Phone:262-884-4088
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:8400 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-3735
Practice Address - Country:US
Practice Address - Phone:262-884-4088
Practice Address - Fax:443-481-6515
Is Sole Proprietor?:No
Enumeration Date:2006-02-18
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89130207Q00000X
MDD66570207Q00000X
WI82154207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD413802300Medicaid
S3990045OtherCAREFIRTS BCBS
1697390OtherAETNA HMO
269666OtherKAISER
7736577OtherAETNA PPO
KJ77AN92322401OtherCAREFIRST
WI100241339Medicaid
FL273737000Medicaid
FLI28465Medicare UPIN
269666OtherKAISER
1697390OtherAETNA HMO