Provider Demographics
NPI:1689654105
Name:CROSKEY, KENT LOREN (DO)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:LOREN
Last Name:CROSKEY
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 1:3421 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5401
Mailing Address - Country:US
Mailing Address - Phone:319-272-5000
Mailing Address - Fax:192-725-2643
Practice Address - Street 1:3421 W 9TH ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5401
Practice Address - Country:US
Practice Address - Phone:319-272-5000
Practice Address - Fax:319-272-5264
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01797207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1268342Medicaid
IA37983OtherWELLMARK BCBS
IA37983OtherWELLMARK BCBS
A01673Medicare UPIN