Provider Demographics
NPI:1386653442
Name:CROW, SUE ELLA (MD)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:ELLA
Last Name:CROW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:14100 NACOGDOCHES RD
Mailing Address - Street 2:STE 116
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-1903
Mailing Address - Country:US
Mailing Address - Phone:210-653-8989
Mailing Address - Fax:210-590-4608
Practice Address - Street 1:14100 NACOGDOCHES RD
Practice Address - Street 2:STE 116
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-1903
Practice Address - Country:US
Practice Address - Phone:210-653-8989
Practice Address - Fax:210-590-4608
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2013-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH2321207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00681ROtherBLUE CROSS BLUE SHEILD
TX121206004OtherMEDICAID EPSDT
TX121206005Medicaid
TX380000649OtherMEDICARE RAILROAD
TX8446N0OtherBLUE CROSS BLUE SHIELD
TX8K9696OtherPRINCETON MEDICAL GROUP PA
TX149747101Medicaid
TX00681ROtherBLUE CROSS BLUE SHEILD
TX149747101Medicaid
TX380000649OtherMEDICARE RAILROAD