Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 7001292 | TN |
NPI | 1396041026 |
---|---|
Provider Name | Dr. Claude Howard Crockett JR. |
First Address | Bristol, VA 24201-1522 |
Second Address | Bristol, VA 24201-1522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2011 |
Last Update Date | 27/01/2011 |