Provider Demographics
NPI:1952352908
Name:CROOM, JOHN E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:CROOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4400 BROADWAY
Mailing Address - Street 2:SUITE 520
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3498
Mailing Address - Country:US
Mailing Address - Phone:816-531-4080
Mailing Address - Fax:816-531-0281
Practice Address - Street 1:4400 BROADWAY
Practice Address - Street 2:SUITE 520
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3498
Practice Address - Country:US
Practice Address - Phone:816-531-4080
Practice Address - Fax:816-531-0281
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060040832084N0400X
KS04-317752084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200381380AMedicaid
MO200644508Medicaid
36305017OtherBCBS
7438509OtherAETNA
KS200381380BMedicaid
7438509OtherAETNA
A35087Medicare UPIN
36305017OtherBCBS
MO200644508Medicaid
KS200381380BMedicaid
MOMA3554006Medicare PIN