Provider Demographics
NPI:1013961994
Name:CROOM, JAMES C (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:CROOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 HIGHWAY 5 N STE 20
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3031
Mailing Address - Country:US
Mailing Address - Phone:870-425-6212
Mailing Address - Fax:870-508-6896
Practice Address - Street 1:230 HIGHWAY 5 N STE 20
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3031
Practice Address - Country:US
Practice Address - Phone:870-425-6212
Practice Address - Fax:870-508-6896
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6073207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR101997001Medicaid
D04394Medicare UPIN
AR101997001Medicaid