=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174862916
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. DANIEL LEWIS CROOM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2013
-----------------------------------------------------
Last Update Date | 05/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | NAVAL HOSPITAL PENSACOLA 6000 W HIGHWAY 98
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32512-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-452-5638
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2005 KNIGHT LAND BLDG H ATTN: MEDICAL STAFF SERVICES, NAVY
-----------------------------------------------------
City | JACKSONVILE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 28027
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------