Provider Demographics
NPI:1033210851
Name:CROTTY, ROBERT ANTON (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANTON
Last Name:CROTTY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N PERKINS RD
Mailing Address - Street 2:STE A
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-5524
Mailing Address - Country:US
Mailing Address - Phone:405-743-3668
Mailing Address - Fax:405-743-1718
Practice Address - Street 1:120 N PERKINS RD
Practice Address - Street 2:STE A
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075
Practice Address - Country:US
Practice Address - Phone:405-743-3668
Practice Address - Fax:405-743-1718
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK167213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK480179134OtherRAILROAD MEDICARE
OK731313428001OtherBLUE CROSS BLUE SHIELD
T40740Medicare UPIN
OKOKAAA3570Medicare PIN
OK0220270001Medicare NSC