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General NPI Number Information
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NPI Number | 1265758460
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Entity Type | Organization
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Legal Business Name | JOHN A CROCKETT MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/13/2010
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Last Update Date | 12/22/2022
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Provider Practice Location Address
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Address Line | 240 LA CASA VIA STE 100
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City | WALNUT CREEK
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State | CA
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Zip | 94598-4863
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Country | US
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Telephone | 925-519-2866
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Fax | 925-692-5522
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Provider Business Mailing Address
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Address Line | 210 LA COLINA DR
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City | ALAMO
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State | CA
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Zip | 94507-1816
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Country | US
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Telephone | 925-519-2866
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Fax | 925-692-5522
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Authorized Official
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Title or Position | CREDENTIALER
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Name | KARL F STEMMLER
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Credential | MPA
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Telephone | 619-258-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | G230620
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G230620
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License Number State | CA
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