Provider Demographics
NPI:1295293496
Name:LANKFORD, JOSEPH CROCKETT (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CROCKETT
Last Name:LANKFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 512185
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10660 PARK RD STE 4100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8551
Practice Address - Country:US
Practice Address - Phone:704-541-8207
Practice Address - Fax:704-540-8288
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2025-01745208800000X
CAA193346208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology