Healthcare Provider Details

I. General information

NPI: 1053318717
Provider Name (Legal Business Name): CHRISTOPHER C CROOT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 BYPASS RD BLDG A
PIKEVILLE KY
41501-1689
US

IV. Provider business mailing address

PO BOX 432
PIKEVILLE KY
41502-0432
US

V. Phone/Fax

Practice location:
  • Phone: 606-430-2212
  • Fax: 606-433-0638
Mailing address:
  • Phone: 606-430-2212
  • Fax: 606-433-0638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number14930
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number48124
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: