Provider Demographics
NPI:1073505889
Name:CROCKER, SCOTT HARRISON (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:HARRISON
Last Name:CROCKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1680 ANTILLEY RD
Mailing Address - Street 2:STE. 260
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5267
Mailing Address - Country:US
Mailing Address - Phone:325-691-5590
Mailing Address - Fax:325-691-1231
Practice Address - Street 1:1680 ANTILLEY RD
Practice Address - Street 2:STE. 260
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5267
Practice Address - Country:US
Practice Address - Phone:325-691-5590
Practice Address - Fax:325-691-1231
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1569208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1157661-04Medicaid
TXB22031Medicare UPIN
TX1157661-04Medicaid