Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 38093 | AZ |
NPI | 1003811068 |
---|---|
Provider Name | Christine Crowder |
First Address | Flagstaff, AZ 86001-7304 |
Second Address | Flagstaff, AZ 86001-7304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 19/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H64660 | (02) | FL |