Individual
CHARLENE CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3925 OLD REDWOOD HWY, SANTA ROSA, CA 95403-1719
(707) 393-4033
Mailing address
3925 OLD REDWOOD HWY, SANTA ROSA, CA 95403-1719
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
191905
CA
207W00000X
Ophthalmology Physician
75772
GA
207W00000X
Ophthalmology Physician
MD459666
PA
207W00000X
Ophthalmology Physician
P9827
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
349043503
—
TX
05
—
349043504
—
TX
05
—
349043505
—
TX
Enumeration date
04/29/2011
Last updated
12/18/2023
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