MEDICARE: GORDON E. CROFOOT M.D., P.A.

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	207R00000X	Internal Medicine Physician	E9592	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588655435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GORDON E. CROFOOT M.D., P.A.

Provider Business Mailing Address
First Line	:	3701 KIRBY DR
Second Line	:	SUITE 1230
City	:	HOUSTON
State	:	TX
Zip	:	77098-3900
Country	:	US
Telephone Number	:	713-526-0005
Fax Number	:	713-524-1602

Provider Business Practice Location Address
First Line	:	3701 KIRBY DR
Second Line	:	SUITE 1230
City	:	HOUSTON
State	:	TX
Zip	:	77098-3900
Country	:	US
Telephone Number	:	713-526-0005
Fax Number	:	713-524-1602

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GORDON E CROFOOT JR.
Credential	:	M.D.
Telephone Number	:	713-526-0005

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	02/24/2012

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