Provider Demographics
NPI:1558321448
Name:CROFT, CAROL LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LYNN
Last Name:CROFT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8440 WALNUT HILL LN STE 540
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3824
Mailing Address - Country:US
Mailing Address - Phone:972-415-2409
Mailing Address - Fax:833-615-2157
Practice Address - Street 1:8440 WALNUT HILL LN STE 540
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3824
Practice Address - Country:US
Practice Address - Phone:972-415-2409
Practice Address - Fax:833-615-2157
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2940208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105921402Medicaid
88G067Medicare ID - Type Unspecified