Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 30557 | SC |
NPI | 1275520629 |
---|---|
Provider Name | Dr. Tamera D Crowe |
First Address | New Albany, IN 47150-9562 |
Second Address | Columbia, SC 29201-2623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2005 |
Last Update Date | 29/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FQC030 | (05) | SC |
FQC043 | (05) | SC |