Basic Information
| Provider Information | |||||||||
| NPI: | 1497909303 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROWE | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | ELLIOTT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2006 FRANKLIN ST SE | ||||||||
| Address2: | STE 301 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565399471 | ||||||||
| FaxNumber: | 2565399472 | ||||||||
| Practice Location | |||||||||
| Address1: | 2006 FRANKLIN ST SE | ||||||||
| Address2: | STE 301 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565399471 | ||||||||
| FaxNumber: | 2565399472 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2008 | ||||||||
| LastUpdateDate: | 11/14/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 31583 | AL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0511-26174 | 01 | AL | BLUE CROSS BLUE SHIELD ALABAMA | OTHER | P01208730 | 01 | GA | RAILROAD MEDICARE | OTHER | 0511-26173 | 01 | AL | BLUE CROSS BLUE SHIELD ALABAMA | OTHER | 0511-26137 | 01 | AL | BLUE CROSS BLUE SHIELD ALABAMA | OTHER | 1497909303 | 05 | AL | MEDICAID |