Organization
GLENN CROWSON MD INC
Active
Other names
Wewoka Medical Rural Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN ALVIN CROWSON MD (CEO)
(405) 257-3396
Entity
Organization
Contact information
Practice address
1401 W 1ST ST, WEWOKA, OK 74884-5097
(405) 257-3396
(405) 257-6908
Mailing address
PO BOX 1093, WEWOKA, OK 74884-1093
(405) 257-3396
(405) 257-6908
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
13854
OK
261QR1300X
Rural Health Clinic/Center
Primary
13854
OK
363L00000X
Nurse Practitioner
R0073222
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100156370A
—
OK
05
—
100740370B
—
OK
05
—
100740370C
—
OK
05
—
200015980A
—
OK
Enumeration date
08/31/2005
Last updated
06/11/2015
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