Provider Demographics
NPI:1356315923
Name:CROOM, JOHN A (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:CROOM
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 1:4300 NE 137TH ST
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:FL
Mailing Address - Zip Code:32617-2319
Mailing Address - Country:US
Mailing Address - Phone:352-629-2534
Mailing Address - Fax:304-523-2241
Practice Address - Street 1:1834 SW 1ST AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-5100
Practice Address - Country:US
Practice Address - Phone:352-732-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA1695207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE0298BMedicare PIN
S50649Medicare UPIN