Provider Demographics
NPI:1275975302
Name:CROTTY, DAVID WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAM
Last Name:CROTTY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1310 CLUB DR
Mailing Address - Street 2:MARE ISLAND
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94592-1187
Mailing Address - Country:US
Mailing Address - Phone:707-638-5216
Mailing Address - Fax:707-638-5946
Practice Address - Street 1:1310 CLUB DR
Practice Address - Street 2:MARE ISLAND
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94592-1187
Practice Address - Country:US
Practice Address - Phone:707-638-5216
Practice Address - Fax:707-638-5946
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
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Provider Licenses
StateLicense IDTaxonomies
CACA4982204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE08850Medicare UPIN