Provider Demographics
NPI:1841254810
Name:BARCROFT, DOUGLAS (FNP)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:BARCROFT
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 KNIGHT ARNOLD RD
Mailing Address - Street 2:322
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-3035
Mailing Address - Country:US
Mailing Address - Phone:901-369-4949
Mailing Address - Fax:901-369-6029
Practice Address - Street 1:3960 KNIGHT ARNOLD RD
Practice Address - Street 2:322
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-3035
Practice Address - Country:US
Practice Address - Phone:901-369-4949
Practice Address - Fax:901-369-6029
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000096987207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP85622Medicare UPIN
TN3909137Medicare ID - Type UnspecifiedMEDICARE