Healthcare Provider Details

I. General information

NPI: 1649533183
Provider Name (Legal Business Name): DOUGLAS L CROFF DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 5TH AVE # 3W
SPOKANE WA
99202-1334
US

IV. Provider business mailing address

400 E 5TH AVE # 3W
SPOKANE WA
99202-1334
US

V. Phone/Fax

Practice location:
  • Phone: 509-724-4481
  • Fax: 509-342-3416
Mailing address:
  • Phone: 509-724-4481
  • Fax: 509-342-3416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberE5200
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO60986928
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: