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General NPI Number Information
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NPI Number | 1487713400
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Entity Type | Organization
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Legal Business Name | DR. JAMES M CROAK, INC.
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 03/06/2018
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Provider Practice Location Address
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Address Line | 28442 E RIVER RD STE 111
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City | PERRYSBURG
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State | OH
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Zip | 43551-2795
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Country | US
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Telephone | 419-893-7134
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Fax | 419-893-6942
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Provider Business Mailing Address
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Address Line | 28442 E RIVER RD STE 111
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City | PERRYSBURG
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State | OH
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Zip | 43551-2795
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Country | US
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Telephone | 419-893-7134
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Fax | 419-893-6942
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Authorized Official
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Title or Position | OWNER
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Name | ANDREW J. CROAK
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Credential | D.O.
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Telephone | 419-893-7134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 07610-NP
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | NP-01213
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | COA-16001
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License Number State | OH
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Taxonomy #6
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number | 34-00-6843-C
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License Number State | OH
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