Individual
DAVID CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
UNIVERSITY OF UTAH SCHOOL OF MEDICINE 30 N 1900 E 1C026, SALT LAKE CITY, UT 84132-2147
(801) 581-2417
Mailing address
975 E 3RD ST, ATT: VELVET GREEN, PROGRAM COORDINATOR EM RESIDENCY, CHATTANOOGA, TN 37403-2147
(423) 778-7673
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
11680436-1205
UT
207P00000X
Emergency Medicine Physician
59020
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/24/2017
Last updated
11/12/2021
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