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Individual
JAY ANTON CROCKETT
Active
Individual
JAY ANTON CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
20317
SC
Other
Enumeration date
06/27/2005
Last updated
02/02/2018
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