Provider Demographics
NPI:1225060031
Name:CROCHELT, ROBERT F (MD, PHD, FACS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F
Last Name:CROCHELT
Suffix:
Gender:M
Credentials:MD, PHD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4533
Mailing Address - Country:US
Mailing Address - Phone:707-463-8011
Mailing Address - Fax:
Practice Address - Street 1:246 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4533
Practice Address - Country:US
Practice Address - Phone:707-462-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT35923208600000X
CAG069042208600000X
WV22713208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001953070OtherMOUNTAIN STATE BCBS
WV22713OtherMEDICAL LICENSE
MT1225060031Medicaid
WA0170620OtherWASHINGTON L&I
WVWV01756OtherHEALTH PLAN
WV3810008522Medicaid
AK020032890OtherMEDICARE RAILRAOD
WVP00389615OtherRAILROAD MEDICARE
WVCR4204692Medicare PIN
WV001953070OtherMOUNTAIN STATE BCBS
WA0170620OtherWASHINGTON L&I
WV22713OtherMEDICAL LICENSE
MT1225060031Medicaid
WV3810008522Medicaid
AK020032890OtherMEDICARE RAILRAOD
AKF58277Medicare UPIN