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NPI Code Detail

MEDICARE: LYNN ANN CROCKER D.O.

MEDICARE: LYNN ANN CROCKER D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician3966AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558357947
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNN ANN CROCKER D.O.
Provider Business Mailing Address
First Line : PO BOX 29834
Second Line :
City : PHOENIX
State : AZ
Zip : 85038-9834
Country : US
Telephone Number : 602-553-8400
Fax Number : 602-553-8408
Provider Business Practice Location Address
First Line : 1111 E MCDOWELL RD
Second Line : WT LL1 CASE MANAGEMENT
City : PHOENIX
State : AZ
Zip : 85006-2612
Country : US
Telephone Number : 602-839-2000
Fax Number : 602-839-5918
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2005
Last Update Date : 03/11/2015

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Directions to “ LYNN ANN CROCKER D.O.” Practice Location

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