Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 20046 | AL |
NPI | 1003866005 |
---|---|
Provider Name | Ladonna M. Crews |
First Address | Mobile, AL 36640-0480 |
Second Address | Mobile, AL 36604-1512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 29/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000078953 | (05) | AL |
00119365 | (05) | MS |
12-10787 | UNITED HEALTHCARE (01) | AL |
261160100 | (05) | FL |
51078953 | BCBS (01) | AL |
G77444 | (02) |