Jack R Crowder, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

MD07408 Issued in TN

Practice address

2002 Brookside Dr
Suite 300
Kingsport, TN 37660-4634

Phone

(423) 392-6370

Fax

(423) 392-6736

NPI assigned

Apr 17, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283126400000",
    "number": "1447214382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2002 BROOKSIDE DR",
            "address_2": "SUITE 300",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604634",
            "telephone_number": "423-392-6370",
            "fax_number": "423-392-6736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 BROOKSIDE DR",
            "address_2": "SUITE 300",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604634",
            "telephone_number": "423-392-6370",
            "fax_number": "423-392-6736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROWDER",
        "first_name": "JACK",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-17",
        "last_updated": "2010-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TN",
            "license": "MD07408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "2005847",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3160026",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "TN01L6",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ryan Patrick Cronin, DO
• Audrey B Cross, FNP
• Kyle K Cross
• Terri Jeanne Cross, MA
• Donna Howard Crotts, COTA
• Jerry Marvin Crowe Jr., DDS
• Jennifer Marie Crowley-Rodig, ARNP
• Chelsea Jeanette Cruey, RN
• Julia Wallin Culligan, PH.D.
• Lauren Ashley Cullins, APRN, CPNP-AC

• Obstetrics & Gynecology Physician in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Obstetrics & Gynecology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.