MEDICARE: DR. DAVID DEAN CROFOOT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	008917	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000917	OTHER	ME	ANTHEM
2	002915	OTHER	ME	TRICARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184624942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID DEAN CROFOOT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 385
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-0385
Country	:	US
Telephone Number	:	207-338-4211
Fax Number	:	207-338-0197

Provider Business Practice Location Address
First Line	:	16 FAHEY ST
Second Line	:	207 COBB MEDICAL BUILDING
City	:	BELFAST
State	:	ME
Zip	:	04915-6029
Country	:	US
Telephone Number	:	207-338-4211
Fax Number	:	207-338-0197

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	03/01/2012

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