Provider Demographics
NPI:1275660060
Name:CROOK, ROBERT (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:CROOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2339 MCCALLIE AVE
Mailing Address - Street 2:PLAZA II, SUITE 407
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3256
Mailing Address - Country:US
Mailing Address - Phone:423-698-8701
Mailing Address - Fax:423-698-0720
Practice Address - Street 1:2339 MCCALLIE AVE
Practice Address - Street 2:PLAZA II, SUITE 407
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3256
Practice Address - Country:US
Practice Address - Phone:423-698-8701
Practice Address - Fax:423-698-0720
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO814208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3838799Medicaid
TN3129796OtherBLUE SHIELD
TN3838799Medicaid
TNF39508Medicare UPIN