Individual
RANDALL B CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1121 S MAIN ST, SNOWFLAKE, AZ 85937-5645
(928) 536-5858
(928) 536-2196
Mailing address
1121 S MAIN ST, SNOWFLAKE, AZ 85937-5645
(928) 536-5858
(928) 536-2196
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7107
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
433696
—
AZ
Enumeration date
12/15/2006
Last updated
04/12/2024
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