Provider Demographics
NPI:1164499588
Name:CROY, DAVID W (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:CROY
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 1:100 MERCY WAY
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4524
Mailing Address - Country:US
Mailing Address - Phone:417-782-7722
Mailing Address - Fax:417-556-3098
Practice Address - Street 1:100 MERCY WAY
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4524
Practice Address - Country:US
Practice Address - Phone:417-782-7722
Practice Address - Fax:417-556-3098
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD110479207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100179260BMedicaid
MO2553OtherBLUE CROSS
MOP00964910OtherRAIL ROAD MEDICARE
MO208262501Medicaid
KS100189640BMedicaid
MO208262501Medicaid
MOMA2082198Medicare PIN
MO003011738Medicare ID - Type Unspecified
MO208262501Medicaid