Provider Demographics
NPI:1225341472
Name:CROOK, ERIC JAMES (PA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JAMES
Last Name:CROOK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2564 QUEENSGATE DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9109
Mailing Address - Country:US
Mailing Address - Phone:509-942-2355
Mailing Address - Fax:509-222-1289
Practice Address - Street 1:2564 QUEENSGATE DR STE 2580
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-9109
Practice Address - Country:US
Practice Address - Phone:888-227-3312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00000363AM0700X
WAPA60253264363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70986FMedicaid
CA551973Medicare Oscar/Certification
CAFHC70986FMedicaid