Healthcare Provider Details

I. General information

NPI: 1891738357
Provider Name (Legal Business Name): RODNEY CROCK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8770 OHIO RIVER RD
WHEELERSBURG OH
45694-1918
US

IV. Provider business mailing address

2124 WALLER ST
PORTSMOUTH OH
45662-2965
US

V. Phone/Fax

Practice location:
  • Phone: 740-574-9090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number34008027
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: