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General NPI Number Information
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NPI Number | 1700886272
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Entity Type | Individual
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Provider Name | DANIEL LIND CROCKER M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/27/2005
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Last Update Date | 09/21/2018
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Provider Practice Location Address
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Address Line | 1041 NOELL LN SUITE 105
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-2058
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Country | US
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Telephone | 252-451-2700
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Fax | 252-451-2702
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Provider Business Mailing Address
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Address Line | 325 BROAD ST STE 100
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City | SUMTER
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State | SC
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Zip | 29150-4167
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Country | US
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Telephone | 803-773-5227
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Fax | 803-746-7445
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 16848
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 16848
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License Number State | NC
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