Healthcare Provider Details

I. General information

NPI: 1992239883
Provider Name (Legal Business Name): CHARLES P CROOKS II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 W THOMAS RD # 403
PHOENIX AZ
85013-4407
US

IV. Provider business mailing address

240 W THOMAS RD # 403
PHOENIX AZ
85013-4407
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-6262
  • Fax: 602-406-6261
Mailing address:
  • Phone: 602-406-6262
  • Fax: 602-406-6261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number69477
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD61146866
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: