Healthcare Provider Details

I. General information

NPI: 1033210851
Provider Name (Legal Business Name): ROBERT ANTON CROTTY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N PERKINS RD STE A
STILLWATER OK
74075
US

IV. Provider business mailing address

120 N PERKINS RD STE A
STILLWATER OK
74075-5524
US

V. Phone/Fax

Practice location:
  • Phone: 405-743-3668
  • Fax: 405-743-1718
Mailing address:
  • Phone: 405-743-3668
  • Fax: 405-743-1718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number167
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: