Provider Demographics
NPI:1205008604
Name:CROCKARELL, JOHN REAMS SR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:REAMS
Last Name:CROCKARELL
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2645 HALLE PKWY
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-8802
Mailing Address - Country:US
Mailing Address - Phone:901-861-2645
Mailing Address - Fax:901-861-2646
Practice Address - Street 1:2645 HALLE PKWY
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-8802
Practice Address - Country:US
Practice Address - Phone:901-861-2645
Practice Address - Fax:901-861-2646
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNM.D.5304207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery