Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 01054675 | IN |
NPI | 1013931989 |
---|---|
Provider Name | David E. Crook |
First Address | Indianapolis, IN 46206-6069 |
Second Address | Indianapolis, IN 46107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 30/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200434040 | (05) | IN |
I15027 | (02) | IN |