Provider Demographics
NPI:1730381005
Name:CROFOOT, GORDON E JR (MD)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:E
Last Name:CROFOOT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 KIRBY DR
Mailing Address - Street 2:SUITE 1230
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3900
Mailing Address - Country:US
Mailing Address - Phone:713-526-0005
Mailing Address - Fax:
Practice Address - Street 1:3701 KIRBY DR STE 1230
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3916
Practice Address - Country:US
Practice Address - Phone:713-526-0005
Practice Address - Fax:855-802-2503
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9592207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115207604Medicaid