Healthcare Provider Details

I. General information

NPI: 1861645392
Provider Name (Legal Business Name): DARRELL G. CROFT, DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 EXETER RD SUITE 200
GERMANTOWN TN
38138-3964
US

IV. Provider business mailing address

2120 EXETER RD SUITE 200
GERMANTOWN TN
38138-3964
US

V. Phone/Fax

Practice location:
  • Phone: 901-756-1680
  • Fax: 901-755-3389
Mailing address:
  • Phone: 901-756-1680
  • Fax: 901-755-3389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDPM412
License Number StateTN

VIII. Authorized Official

Name: DR. DARRELL GLENN CROFT
Title or Position: OWNER
Credential: DPM
Phone: 901-756-1680