Provider Demographics
NPI:1669545299
Name:CROW, JESSICA L (DO)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:CROW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-1214
Mailing Address - Country:US
Mailing Address - Phone:419-423-5262
Mailing Address - Fax:419-423-5550
Practice Address - Street 1:1900 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1214
Practice Address - Country:US
Practice Address - Phone:419-423-5221
Practice Address - Fax:419-423-5143
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.009166208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00640558OtherMEDICARE RAILROAD
OH2794454Medicaid
OHP00640558OtherMEDICARE RAILROAD