Provider Demographics
NPI:1265473466
Name:CROFFORD, THEODORE W (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:W
Last Name:CROFFORD
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 1:6301 HARRIS PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4245
Mailing Address - Country:US
Mailing Address - Phone:817-877-3432
Mailing Address - Fax:817-346-4394
Practice Address - Street 1:6301 HARRIS PKWY STE 300
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4245
Practice Address - Country:US
Practice Address - Phone:817-877-3432
Practice Address - Fax:817-346-4394
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0273207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080486601Medicaid
TN80093YOtherBLUE CROSS & BLUE SHIELD
TX137134612Medicaid
TX8370J3Medicare PIN
TX267668YKPWMedicare PIN
TX137134612Medicaid