Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | ME11636 | FL |
NPI | 1033123690 |
---|---|
Provider Name | Ben M Crowder |
First Address | Winter Haven, FL 33880-3050 |
Second Address | Winter Haven, FL 33880-3050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 24/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
048370200 | (05) | FL |
D59381 | (02) |