Provider Demographics
NPI:1164497145
Name:CREWS, ALAN L (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:L
Last Name:CREWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 809
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-0809
Mailing Address - Country:US
Mailing Address - Phone:423-775-6668
Mailing Address - Fax:423-775-1054
Practice Address - Street 1:163 WALNUT GROVE CHURCH RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-5905
Practice Address - Country:US
Practice Address - Phone:423-775-6668
Practice Address - Fax:423-775-1054
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD14949174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA97699Medicare UPIN
TN3012992Medicare ID - Type Unspecified