Individual
JAY ANTON CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
20317
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
576007863136
BCBS OF SC
SC
01
—
576007863153
BLUE CHOICE
SC
01
—
P00802351
RR MEDICARE
SC
05
—
T46019
—
SC
Enumeration date
06/27/2005
Last updated
02/02/2018
Update your record
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