1710938022 NPI number — ROY MICHAEL CROWNOVER JR. MD

Table of content: ADRIAN GROPPER M.D. (NPI 1891022661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710938022 NPI number — ROY MICHAEL CROWNOVER JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROWNOVER
Provider First Name:
ROY
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710938022
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1326 HILLTOP RDG
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BRAUNFELS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78132-2289
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-964-3274
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 N UNION AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRAUNFELS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78130-4194
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-643-6166
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  M4014 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 181370106 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8V2234 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 181370102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 181370105 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8K0532 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 181370101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 181370109 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8M6796 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8X7467 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8W0380 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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