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NPI Code Detail

MEDICARE: GORDON E CROFOOT JR. MD

MEDICARE: GORDON E CROFOOT JR. MD
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
1207R00000XInternal Medicine PhysicianE9592TX

Other Identifiers

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

General Provider Information

NPI Number : 1730381005
Entity Type Code : Individual
Provider Name (Legal Business Name) : GORDON E CROFOOT JR. MD
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 :
Provider Business Practice Location Address
First Line : 3701 KIRBY DR STE 1230
Second Line :
City : HOUSTON
State : TX
Zip : 77098-3916
Country : US
Telephone Number : 713-526-0005
Fax Number : 855-802-2503
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2007
Last Update Date : 02/20/2023

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