Provider Demographics
NPI:1285994434
Name:CROFOOT, AARON BROOKS (MD)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:BROOKS
Last Name:CROFOOT
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 1:229 W NORTH SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1142
Mailing Address - Country:US
Mailing Address - Phone:574-233-7642
Mailing Address - Fax:
Practice Address - Street 1:229 W NORTH SHORE DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-1142
Practice Address - Country:US
Practice Address - Phone:574-233-7642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023800A207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services