Provider Demographics
NPI:1932169836
Name:CROWELL, JOHN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:CROWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2154 BALSAN WAY
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6109
Mailing Address - Country:US
Mailing Address - Phone:561-790-0216
Mailing Address - Fax:561-795-8975
Practice Address - Street 1:10131 FOREST HILL BLVD
Practice Address - Street 2:STE 101
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6109
Practice Address - Country:US
Practice Address - Phone:561-798-4455
Practice Address - Fax:561-798-2730
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0037812207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5408151OtherAETNA
FL58333Medicare ID - Type Unspecified
FL5408151OtherAETNA