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General NPI Number Information
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NPI Number | 1417035684
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Entity Type | Organization
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Legal Business Name | KEVIN W CROFT, M.D.
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 06/24/2016
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Provider Practice Location Address
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Address Line | 5389 N 1ST AVE
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City | DURANT
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State | OK
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Zip | 74701-2599
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Country | US
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Telephone | 580-924-5211
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Fax |
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Provider Business Mailing Address
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Address Line | 5389 N 1ST AVE
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City | DURANT
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State | OK
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Zip | 74701-2599
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Country | US
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Telephone | 580-924-5211
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN WALLACE CROFT
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Credential | M.D.
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Telephone | 580-924-5211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 32094
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 19261
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License Number State | OK
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