Individual
SAMUEL E CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2520 N ORANGE AVE, SUITE 102, ORLANDO, FL 32804-4638
(407) 303-2801
(407) 303-2805
Mailing address
2520 N ORANGE AVE, SUITE 102, ORLANDO, FL 32804-4638
(407) 303-2801
(407) 303-2805
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
ME31027
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
48932
BCBS
FL
Enumeration date
06/15/2006
Last updated
08/17/2007
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