Provider Demographics
NPI:1376576827
Name:CROCKETT, EMILY B (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:B
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1000 POLE CREEK CROSSING
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-2900
Mailing Address - Country:US
Mailing Address - Phone:308-254-5825
Mailing Address - Fax:308-254-0396
Practice Address - Street 1:1000 POLE CREEK XING STE 1
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-2902
Practice Address - Country:US
Practice Address - Phone:308-254-5544
Practice Address - Fax:308-254-0396
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE31335207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO080162431OtherRAILROAD MEDICARE
COC376408Medicare PIN
CO080162431OtherRAILROAD MEDICARE