Provider Demographics
NPI:1518949684
Name:CROSHAW, DAVID K (DPM)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:K
Last Name:CROSHAW
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1155 POCATELLO CREEK RD
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2949
Mailing Address - Country:US
Mailing Address - Phone:208-232-0006
Mailing Address - Fax:208-233-8771
Practice Address - Street 1:1155 POCATELLO CREEK RD
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2949
Practice Address - Country:US
Practice Address - Phone:208-232-0006
Practice Address - Fax:208-233-8771
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP92213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000806000Medicaid
ID000806000Medicaid
T44251Medicare UPIN