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
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