Individual
EDWARD FRANK CROCKER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
255 BAPTIST BLVD, SUITE 401, COLUMBUS, MS 39705-2011
(662) 244-2288
(662) 244-2289
Mailing address
965 RIDGE LAKE BLVD STE 103, MEMPHIS, TN 38120-9446
(901) 227-3255
(901) 227-8591
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
17871
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05082097
—
MS
01
—
731-04786
BCBS AL
AL
Enumeration date
06/23/2006
Last updated
02/05/2015
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