Provider Demographics
NPI:1972689636
Name:CROOK, SHAWN J (DO)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:J
Last Name:CROOK
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:GREAT FALLS CLINIC HOSPITAL
Mailing Address - Street 2:3010 15TH AVENUE SOUTH
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405
Mailing Address - Country:US
Mailing Address - Phone:406-216-8000
Mailing Address - Fax:
Practice Address - Street 1:GREAT FALLS CLINIC HOSPITAL
Practice Address - Street 2:3010 15TH AVENUE SOUTH
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405
Practice Address - Country:US
Practice Address - Phone:406-216-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006018414207L00000X, 207P00000X
MT59462207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2006018414OtherSTATE MEDICAL LICENSE
MT59462OtherSTATE MEDICAL LICENSE