Provider Demographics
NPI:1184168916
Name:CROUGH PODIATRY
Entity type:Organization
Organization Name:CROUGH PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKSON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:760-507-2070
Mailing Address - Street 1:777 E TAHQUITZ CANYON WAY
Mailing Address - Street 2:SUITE 200-096
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6784
Mailing Address - Country:US
Mailing Address - Phone:760-507-2070
Mailing Address - Fax:760-507-2071
Practice Address - Street 1:1180 N INDIAN CANYON DR
Practice Address - Street 2:SUITE 201
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4800
Practice Address - Country:US
Practice Address - Phone:760-416-4511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5290213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty