Provider Demographics
NPI:1780667188
Name:CROFT, DARRELL GLENN (DPM)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:GLENN
Last Name:CROFT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2120 EXETER RD STE 130
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3900
Mailing Address - Country:US
Mailing Address - Phone:901-756-1680
Mailing Address - Fax:901-755-3389
Practice Address - Street 1:2120 EXETER RD STE 130
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3900
Practice Address - Country:US
Practice Address - Phone:901-756-1680
Practice Address - Fax:901-755-3389
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM412213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06934511Medicaid
TN33518841Medicaid
TNU20463Medicare UPIN
MS480000159Medicare ID - Type Unspecified
TN33518841Medicaid