Provider Demographics
NPI:1497788251
Name:FRANCIS C F DECROOS MD PA
Entity type:Organization
Organization Name:FRANCIS C F DECROOS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:C F
Authorized Official - Last Name:DECROOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-862-4377
Mailing Address - Street 1:928 E MAR WALT DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6601
Mailing Address - Country:US
Mailing Address - Phone:850-862-4377
Mailing Address - Fax:850-862-6015
Practice Address - Street 1:928 E MAR WALT DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6601
Practice Address - Country:US
Practice Address - Phone:850-862-4377
Practice Address - Fax:850-862-6015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46110OtherBLUE CROSS BLUE SHIELD
FL46110OtherBLUE CROSS BLUE SHIELD
FLD54949Medicare UPIN