Healthcare Provider Details

I. General information

NPI: 1225341472
Provider Name (Legal Business Name): ERIC JAMES CROOK P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2564 QUEENSGATE DR STE 2580
RICHLAND WA
99352-9109
US

IV. Provider business mailing address

2564 QUEENSGATE DR
RICHLAND WA
99352-9109
US

V. Phone/Fax

Practice location:
  • Phone: 888-227-3312
  • Fax:
Mailing address:
  • Phone: 509-942-2355
  • Fax: 509-222-1289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number00000
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60253264
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: