Individual
JONATHAN SLADE CROWDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3203 MIDDLE ROAD, COLUMBUS, IN 47203
(812) 373-2700
(812) 373-2710
Mailing address
PO BOX 775383, CHICAGO, IL 60677-5383
(812) 375-3000
(812) 375-3477
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01057432A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000286084
BLUE CROSS ANTHEM
IN
01
—
000000984083
ANTHEM PIN
IN
01
—
01057432A
IN MEDICAL LICENSE
IN
01
—
1407861164
GROUP NPI
—
05
—
200426270A
—
IN
01
—
P00038722
MEDICARE RAILROAD
IN
Enumeration date
05/03/2006
Last updated
08/08/2018
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