Provider Demographics
NPI:1306131370
Name:CROOK, JERRALL P (MD)
Entity type:Individual
Prefix:DR
First Name:JERRALL
Middle Name:P
Last Name:CROOK
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 1:145 THOMPSON LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-2411
Mailing Address - Country:US
Mailing Address - Phone:615-781-0013
Mailing Address - Fax:615-781-0688
Practice Address - Street 1:145 THOMPSON LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-2411
Practice Address - Country:US
Practice Address - Phone:615-781-0013
Practice Address - Fax:615-781-0688
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3446207Y00000X, 207Q00000X, 207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10834071OtherCAQH
TND68887Medicare UPIN