Provider Demographics
NPI:1871582817
Name:CROWE, JOHN KENYON (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KENYON
Last Name:CROWE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3114
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85271-3114
Mailing Address - Country:US
Mailing Address - Phone:480-425-5063
Mailing Address - Fax:480-425-5010
Practice Address - Street 1:3501 N SCOTTSDALE RD STE 130
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5649
Practice Address - Country:US
Practice Address - Phone:480-425-5000
Practice Address - Fax:480-945-6548
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ109112085R0202X
CT0396262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ254053Medicaid
AZWCFKX06Medicare PIN
AZ79046Medicare PIN
AZ254053Medicaid
AZWXMBK0ZMedicare PIN