Basic Information
| Provider Information | |||||||||
| NPI: | 1235316787 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JAMES D CROWTHER M.D. P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3410 EXECUTIVE DR | ||||||||
| Address2: | SUITE # 103 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276097450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198725296 | ||||||||
| FaxNumber: | 9198509718 | ||||||||
| Practice Location | |||||||||
| Address1: | 3410 EXECUTIVE DR | ||||||||
| Address2: | SUITE # 103 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276097450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198725296 | ||||||||
| FaxNumber: | 9198509718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2008 | ||||||||
| LastUpdateDate: | 01/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | JANSEN | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9198725296 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 73202 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | P00274036 | 01 | NC | RAILROAD MEDICARE | OTHER |