Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | MD05289 | RI |
NPI | 1003867268 |
---|---|
Provider Name | Robert Crouse |
First Address | Fall River, MA 02723-1516 |
Second Address | Wakefield, RI 02879-4216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D87204 | (02) | RI |