Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0003X | Hematology & Oncology | 14930 | MS |
Y | 207RH0003X | Hematology & Oncology | 48124 | KY |
NPI | 1053318717 |
---|---|
Provider Name | Christopher C Croot |
First Address | Louisville, KY 40215-1272 |
Second Address | Louisville, KY 40202-1434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 04/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0126054 | (05) | MS |
7100375880 | (05) | KY |
G35036 | (02) | MS |