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General NPI Number Information
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NPI Number | 1255627667
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Entity Type | Individual
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Provider Name | RYAN KELLY CROOKS MD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2011
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Last Update Date | 05/19/2016
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Provider Practice Location Address
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Address Line | 580W 8TH ST TOWER 1, FLOOR 9
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City | JACKSONVILLE
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State | FL
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Zip | 32209
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Country | US
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Telephone | 904-244-9934
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Fax | 904-244-9757
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Provider Business Mailing Address
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Address Line | 580W 8TH ST TOWER 1, FLOOR 9
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City | JACKSONVILLE
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State | FL
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Zip | 32209
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Country | US
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Telephone | 904-244-9934
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Fax | 904-244-9757
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | LL33804
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | TRN17458
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME125442
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License Number State | FL
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