Individual
PERCY VANDORN CROCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
610 PROVIDENCE PARK DR E, BLDG 2, SUITE 203, MOBILE, AL 36695-4622
(251) 633-2667
(251) 633-2179
Mailing address
2880 DAUPHIN ST, MOBILE, AL 36606-2457
(251) 473-1900
(251) 470-8943
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
00006625
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000034516
—
AL
01
—
4006497
AETNA PROVIDER #
AL
01
—
51034516
BLUE CROSS PROVIDER #
AL
01
—
51511130
BLUE CROSS AL PROV #
AL
01
—
51521765
BLUE CROSS AL PROV #
AL
01
—
C71188
HEALTHSPRING PROVIDER #
AL
Enumeration date
05/24/2005
Last updated
11/19/2007
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