Individual
DR. JACOB EMERSON CROTHERS
Active
Individual
DR. JACOB EMERSON CROTHERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
052724
CT
207QA0401X
Addiction Medicine (Family Medicine) Physician
052724
CT
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
Primary
MD20886
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008052299
MEDICAID FOR CROTHERS
CT
01
—
D400163444
MEDICARE FOR CROTHERS
CT
Enumeration date
05/30/2011
Last updated
01/26/2022
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