Individual
DR. JOHN CROCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
366 SIMCOE MT. ROAD, CENTERVILLE, WA 98613
(509) 834-1947
Mailing address
366 SIMCOE MT. ROAD, CENTERVILLE, WA 98613
(509) 834-1947
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
016884
ME
207Q00000X
Family Medicine Physician
MD00019205
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119224
—
OR
Enumeration date
10/16/2006
Last updated
12/12/2007
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