Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2301008769 | MI |
NPI | 1326140955 |
---|---|
Provider Name | Dr. Paul Raymond Crowe |
First Address | Escanaba, MI 49829-1520 |
Second Address | Escanaba, MI 49829-2840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2006 |
Last Update Date | 08/07/2007 |