Basic Information
| Provider Information | |||||||||
| NPI: | 1497702781 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROWE | ||||||||
| FirstName: | CATHERINE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4105 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972084105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669071068 | ||||||||
| FaxNumber: | 4259179141 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 E 36TH AVE | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995084372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075629229 | ||||||||
| FaxNumber: | 9075614806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 02/16/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 23720 | CO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 7068 | AK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080046537 | 01 | CO | RAIL ROAD MEDICARE | OTHER | 23720 | 01 | CO | STATE MEDICAL LICENSE | OTHER | 39924 | 01 | CO | BC/BS ANTHEM | OTHER | 01237205 | 05 | CO | MEDICAID | 1571189 | 05 | AK | MEDICAID |