Basic Information
| Provider Information | |||||||||
| NPI: | 1699730226 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROWELL | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1138 INDEPENDENCE AVE | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 433026318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403837953 | ||||||||
| FaxNumber: | 7403758114 | ||||||||
| Practice Location | |||||||||
| Address1: | 1138 INDEPENDENCE AVE | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 433026318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403837953 | ||||||||
| FaxNumber: | 7403758114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 12/15/2021 | ||||||||
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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 | 207X00000X | 35043917 | OH | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0117X | 35043917 | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | 0554716 | 05 | OH | MEDICAID |