Provider Demographics
NPI:1255627667
Name:CROOKS, RYAN KELLY (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:KELLY
Last Name:CROOKS
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 1:580W 8TH ST
Mailing Address - Street 2:TOWER 1, FLOOR 9
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209
Mailing Address - Country:US
Mailing Address - Phone:904-244-9934
Mailing Address - Fax:904-244-9757
Practice Address - Street 1:580W 8TH ST
Practice Address - Street 2:TOWER 1, FLOOR 9
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209
Practice Address - Country:US
Practice Address - Phone:904-244-9934
Practice Address - Fax:904-244-9757
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL33804207R00000X
FLTRN174582084N0400X
FLME1254422084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine