Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DD1478 | NM |
NPI | 1033250667 |
---|---|
Provider Name | Dr. Keigm L Crook |
First Address | Albuquerque, NM 87109-1405 |
Second Address | Albuquerque, NM 87109-1405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 08/07/2007 |