Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | H1569 | TX |
NPI | 1073505889 |
---|---|
Provider Name | Dr. Scott Harrison Crocker |
First Address | Abilene, TX 79606-5267 |
Second Address | Abilene, TX 79606-5267 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 01/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1157661-04 | (05) | TX |
B22031 | (02) | TX |