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
1	207R00000X	Internal Medicine Physician	3966	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID 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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