Individual
AUSTIN TAYLOR CROCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3556 W 9800 S STE 101, SOUTH JORDAN, UT 84095-3221
(801) 567-9780
Mailing address
3556 W 9800 S STE 101, SOUTH JORDAN, UT 84095-3221
(801) 567-9780
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
14176469-1206
UT
390200000X
Student in an Organized Health Care Education/Training Program
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—
Other
Enumeration date
05/08/2023
Last updated
09/11/2024
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