Provider Demographics
NPI:1053369801
Name:CROWDER, ROWE SANDERS III (MD)
Entity type:Individual
Prefix:
First Name:ROWE
Middle Name:SANDERS
Last Name:CROWDER
Suffix:III
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 1:952 GREEN MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-1620
Mailing Address - Country:US
Mailing Address - Phone:228-463-1649
Mailing Address - Fax:
Practice Address - Street 1:952 GREEN MEADOW RD
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-1620
Practice Address - Country:US
Practice Address - Phone:228-463-1649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14176207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114628Medicaid
MS00114628Medicaid
MS00114628Medicaid