Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | F9336 | TX |
N | 207PE0004X | Emergency Medical Services | F9336 | TX |
NPI | 1184689077 |
---|---|
Provider Name | Mr. Patrick J Crocker |
First Address | Austin, TX 78735 |
Second Address | Austin, TX 78701-1930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 19/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
136726010 | (05) | TX |
A66039 | (02) | TX |