Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 18966 | WV |
NPI | 1023072139 |
---|---|
Provider Name | Dr. R. Joseph Crow JR. |
First Address | Charleston, WV 25301-1842 |
Second Address | Charleston, WV 25301-1842 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0089369000 | (05) | WV |
F10423 | (02) | WV |