Provider Demographics
NPI:1811985146
Name:CROOK, ALBERT ALLEN (DO)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:ALLEN
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 1:1103 W. IRONWOOD DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:COEUR D'ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2604
Mailing Address - Country:US
Mailing Address - Phone:208-667-9400
Mailing Address - Fax:208-667-2119
Practice Address - Street 1:1103 W. IRONWOOD DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:COEUR D'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2604
Practice Address - Country:US
Practice Address - Phone:208-667-9400
Practice Address - Fax:208-667-9400
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID01342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010138014OtherREGENCE BLUE SHIELD OF ID
IDS5452OtherBLUE CROSS OF ID
ID806409200Medicaid
ID000010138014OtherREGENCE BLUE SHIELD OF ID
1376919Medicare ID - Type Unspecified