Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 29360 | KY |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 29360 | KY |
N | 207ND0900X | Dermatopathologist | 29360 | KY |
N | 207NP0225X | Pediatric Dermatologist | 29360 | KY |
N | 207NS0135X | Procedural Dermatology | 29360 | KY |
NPI | 1477667038 |
---|---|
Provider Name | Dr. Michael J Crowe |
First Address | Owensboro, KY 42303-1320 |
Second Address | Owensboro, KY 42303-1320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 24/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6429360800 | (05) | KY |
F09204 | (02) | KY |