Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | L6019 | TX |
NPI | 1578514956 |
---|---|
Provider Name | David R. Crotzer |
First Address | Virginia Beach, VA 23450-0190 |
Second Address | Omaha, NE 68114-4108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 13/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0722033 | (05) | IA |
10025044500 | (05) | NE |
205486103 | (05) | MO |
47037660402 | (05) | NE |
I06112 | (02) | |
P00334395 | RAILROAD MEDICARE (01) | NE |