Healthcare Provider Details

I. General information

NPI: 1275975302
Provider Name (Legal Business Name): DAVID WILLIAM CROTTY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 CLUB DR MARE ISLAND
VALLEJO CA
94592-1187
US

IV. Provider business mailing address

1310 CLUB DR MARE ISLAND
VALLEJO CA
94592-1187
US

V. Phone/Fax

Practice location:
  • Phone: 707-638-5216
  • Fax: 707-638-5946
Mailing address:
  • Phone: 707-638-5216
  • Fax: 707-638-5946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberCA4982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: