Basic Information
| Provider Information | |||||||||
| NPI: | 1649536376 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROWDER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13001 EAST 17TH PLACE | ||||||||
| Address2: | UNIVERSITY OF COLORADO DENVER SCHOOL OF MEDICINE GME | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800452579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037246031 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6424 E BROADWAY RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852061750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804569000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2012 | ||||||||
| LastUpdateDate: | 01/23/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 51075 | AZ | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 405915 | 05 | AZ | MEDICAID |