Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 167 | OK |
Y | 222Z00000X | Podiatrist | 167 | OK |
NPI | 1033210851 |
---|---|
Provider Name | Robert Anton Crotty |
First Address | Stillwater, OK 74075-5524 |
Second Address | Stillwater, OK 74075 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 04/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
480179134 | RAILROAD MEDICARE (01) | OK |
731313428001 | BLUE CROSS BLUE SHIELD (01) | OK |
T40740 | (02) |