Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | H0273 | TX |
NPI | 1265473466 |
---|---|
Provider Name | Theodore W Crofford |
First Address | Fort Worth, TX 76132-4245 |
Second Address | Fort Worth, TX 76132-4245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 27/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080486601 | (05) | TX |
137134612 | (05) | TX |
80093Y | BLUE CROSS & BLUE SHIELD (01) | TN |
B22034 | (02) | TX |