Provider Demographics
NPI:1972555613
Name:CROTTY, JAMES G (DPM)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:CROTTY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1221 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-6249
Mailing Address - Country:US
Mailing Address - Phone:918-682-1720
Mailing Address - Fax:918-682-1332
Practice Address - Street 1:1221 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-6249
Practice Address - Country:US
Practice Address - Phone:918-682-1720
Practice Address - Fax:918-682-1332
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK170213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK234631901Medicare PIN
OK0463010001Medicare NSC