Provider Demographics
NPI:1861645392
Name:DARRELL G. CROFT, DPM
Entity Type:Organization
Organization Name:DARRELL G. CROFT, DPM
Other - Org Name:DARRELL G. CROFT, DPM
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:CROFT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:901-756-1680
Mailing Address - Street 1:2120 EXETER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3964
Mailing Address - Country:US
Mailing Address - Phone:901-756-1680
Mailing Address - Fax:901-755-3389
Practice Address - Street 1:2120 EXETER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3964
Practice Address - Country:US
Practice Address - Phone:901-756-1680
Practice Address - Fax:901-755-3389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM412213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN33518841Medicare PIN