Provider Demographics
NPI:1174862916
Name:CROOM, DANIEL LEWIS
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LEWIS
Last Name:CROOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 KNIGHT LAND BLDG H
Mailing Address - Street 2:ATTN: MEDICAL STAFF SERVICES, NAVY
Mailing Address - City:JACKSONVILE
Mailing Address - State:FL
Mailing Address - Zip Code:32212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2005 KNIGHT LAND BLDG H
Practice Address - Street 2:ATTN: MEDICAL STAFF SERVICES, NAVY MEDICINE SUPPORT COM
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32212
Practice Address - Country:US
Practice Address - Phone:904-542-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE28027207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology