Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 4141 | KY |
NPI | 1639268030 |
---|---|
Provider Name | Dr. Thomas Michael Crevar |
First Address | Bowling Green, KY 42101-2255 |
Second Address | Bowling Green, KY 42101-2255 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |