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NPI Code Detail

MEDICARE: PERCY VANDORN CROCKER M.D.

MEDICARE:   PERCY VANDORN CROCKER  M.D.
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
1207Y00000XOtolaryngology Physician00006625AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2C71188OTHERALHEALTHSPRING PROVIDER #
34006497OTHERALAETNA PROVIDER #
451034516OTHERALBLUE CROSS PROVIDER #
551511130OTHERALBLUE CROSS AL PROV #
651521765OTHERALBLUE CROSS AL PROV #

General Provider Information

NPI Number : 1811990765
Entity Type Code : Individual
Provider Name (Legal Business Name) : PERCY VANDORN CROCKER M.D.
Provider Business Mailing Address
First Line : 2880 DAUPHIN ST
Second Line :
City : MOBILE
State : AL
Zip : 36606-2457
Country : US
Telephone Number : 251-473-1900
Fax Number : 251-470-8943
Provider Business Practice Location Address
First Line : 610 PROVIDENCE PARK DR E
Second Line : BLDG 2, SUITE 203
City : MOBILE
State : AL
Zip : 36695-4622
Country : US
Telephone Number : 251-633-2667
Fax Number : 251-633-2179
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 11/19/2007

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Directions to “ PERCY VANDORN CROCKER M.D.” Practice Location

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