Organization
CHILDREN'S CLINIC OF JASPER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERE CROCKER (OFFICE MANAGER)
(936) 634-2214
Entity
Organization
Contact information
Practice address
1008 DICKERSON DR, JASPER, TX 75951-5111
(936) 634-2214
(936) 639-9660
Mailing address
PO BOX 150638, LUFKIN, TX 75915-0638
(936) 634-2214
(936) 639-9660
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
H4321
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
092130602
—
MD
05
—
191679301
—
TX
Enumeration date
07/14/2016
Last updated
07/14/2016
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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