Provider Demographics
NPI:1316490931
Name:CROOKS, EDWARD FRANCIS (RDMS, RDCS, RVT)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:FRANCIS
Last Name:CROOKS
Suffix:
Gender:M
Credentials:RDMS, RDCS, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 SE HILLMOOR DR
Mailing Address - Street 2:SUITE C-207
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7553
Mailing Address - Country:US
Mailing Address - Phone:678-994-5407
Mailing Address - Fax:
Practice Address - Street 1:1801 SE HILLMOOR DR
Practice Address - Street 2:SUITE C-207
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7553
Practice Address - Country:US
Practice Address - Phone:678-994-5407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-31
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD42861246XS1301X, 2471S1302X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography