Basic Information
| Provider Information | |||||||||
| NPI: | 1396700829 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROW | ||||||||
| FirstName: | JOE | ||||||||
| MiddleName: | WALTER | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4020 RICHARDS RD | ||||||||
| Address2: | |||||||||
| City: | NORTH LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721172650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017711600 | ||||||||
| FaxNumber: | 5019552252 | ||||||||
| Practice Location | |||||||||
| Address1: | 4020 RICHARDS RD | ||||||||
| Address2: | |||||||||
| City: | NORTH LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721172650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017711600 | ||||||||
| FaxNumber: | 5019552252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 07/17/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | C4023 | AR | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 104853001 | 05 | AR | MEDICAID |