Provider Demographics
NPI:1588924658
Name:CROFTS, DOUGLAS ZEB (DO)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ZEB
Last Name:CROFTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:380 W. 100 N.
Mailing Address - City:MONTICELLO
Mailing Address - State:UT
Mailing Address - Zip Code:84535-0308
Mailing Address - Country:US
Mailing Address - Phone:435-587-5054
Mailing Address - Fax:435-587-3004
Practice Address - Street 1:380 W. 100 N.
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:UT
Practice Address - Zip Code:84535-0308
Practice Address - Country:US
Practice Address - Phone:435-587-5054
Practice Address - Fax:435-587-3004
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9461575-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1588924658Medicaid