Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 49273 | AZ |
Y | 207YP0228X | Pediatric Otolaryngology | 49273 | AZ |
NPI | 1225282882 |
---|---|
Provider Name | Dr. David J. Crockett |
First Address | Phoenix, AZ 85016-4872 |
Second Address | Phoenix, AZ 85048-7645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2008 |
Last Update Date | 15/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
922449 | (05) | AZ |