Provider Demographics
NPI:1114933215
Name:CROYLE, DAVID JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JEFFREY
Last Name:CROYLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 DOCTORS PARK
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4928
Mailing Address - Country:US
Mailing Address - Phone:573-334-6071
Mailing Address - Fax:573-334-4739
Practice Address - Street 1:70 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4928
Practice Address - Country:US
Practice Address - Phone:573-334-6071
Practice Address - Fax:573-334-4739
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020152512085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-107225OtherIL BLUE CROSS BLUE SHIELD
063896OtherHEALTH ALLIANCE
430954380CAPOtherMERCY HEALTH PLAN
MO205919707Medicaid
AR149237001Medicaid
MO185214OtherMO BLUE CROSS BLUE SHIELD
481849OtherHEALTHLINK
481849OtherHEALTHLINK
MO023010086Medicare ID - Type Unspecified
IL300134629Medicare ID - Type UnspecifiedIL RAILROAD MEDICARE
AR149237001Medicaid
IL036-107225OtherIL BLUE CROSS BLUE SHIELD