Provider Demographics
NPI:1437372729
Name:CROOK, WALTER JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:JOSEPH
Last Name:CROOK
Suffix:
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 1:1701 NE TECHNOLOGY DRIVE
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201
Mailing Address - Country:US
Mailing Address - Phone:320-231-5906
Mailing Address - Fax:
Practice Address - Street 1:1701 TECHNOLOGY DR NE
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-2275
Practice Address - Country:US
Practice Address - Phone:320-231-5906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL122012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC75765Medicare UPIN
AL000085848CROMedicare ID - Type Unspecified