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General NPI Number Information
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NPI Number | 1710245964
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Entity Type | Individual
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Provider Name | JOSEPH WILLIAM CROOKSHANK III M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/25/2012
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Last Update Date | 03/29/2018
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Provider Practice Location Address
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Address Line | 1747 IMPERIAL BLVD
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City | LAKE CHARLES
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State | LA
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Zip | 70605-5362
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Country | US
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Telephone | 337-721-7236
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Fax | 337-721-7237
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Provider Business Mailing Address
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Address Line | 501 DR MICHAEL DEBAKEY DR
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City | LAKE CHARLES
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State | LA
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Zip | 70601-5724
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Country | US
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Telephone | 337-721-7236
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Fax | 337-721-7237
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 302153
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 302153
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License Number State | LA
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