Individual
DR. JAY D CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
(816) 234-3000
(816) 302-9939
Mailing address
2401 GILLHAM RD., PROVIDER ENROLLMENT, KANSAS CITY, MO 64108-4619
(816) 701-5200
(816) 302-9939
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
05-39181
KS
2085P0229X
Pediatric Radiology Physician
Primary
113275
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
245858501
—
MO
01
—
300133399
RR MEDICARE
MO
Enumeration date
06/15/2006
Last updated
12/23/2025
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