Provider Demographics
NPI:1982729521
Name:CROWE, SUSAN LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LYNN
Last Name:CROWE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:LYNN
Other - Last Name:EVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5742
Mailing Address - Country:US
Mailing Address - Phone:305-831-4761
Mailing Address - Fax:305-831-4761
Practice Address - Street 1:206 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-4902
Practice Address - Country:US
Practice Address - Phone:863-209-7003
Practice Address - Fax:863-284-3083
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105621207Q00000X
ORMD168061207Q00000X
FLME129885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH 52212Medicare UPIN