Individual
DR. MICHELE MARIE CROCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5002 COWHORN CREEK RD, TEXARKANA, TX 75503-9766
(903) 614-3000
Mailing address
5002 COWHORN CREEK RD, TEXARKANA, TX 75503-9766
(903) 614-3000
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD.200782
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5901422
—
NC
Enumeration date
08/08/2006
Last updated
06/09/2008
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