Individual
DAKOTA WOLF CROCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8211
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8311
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD226307
OR
208000000X
Pediatrics Physician
PG211350
OR
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/15/2022
Last updated
07/09/2025
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