Individual
JACK R CROWDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2002 BROOKSIDE DR, SUITE 300, KINGSPORT, TN 37660-4634
(423) 392-6370
(423) 392-6736
Mailing address
2002 BROOKSIDE DR, SUITE 300, KINGSPORT, TN 37660-4634
(423) 392-6370
(423) 392-6736
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD07408
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2005847
BCBS
TN
05
—
3160026
—
TN
01
—
TN01L6
JOHN DEERE
TN
Enumeration date
04/17/2006
Last updated
08/30/2010
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