Provider Demographics
NPI:1508897349
Name:CROKER, BYRON P (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:P
Last Name:CROKER
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:BYRON
Other - Middle Name:P
Other - Last Name:CROKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-273-7839
Mailing Address - Fax:352-392-6249
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-374-6057
Practice Address - Fax:352-379-4023
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43048207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL68291ZMedicare PIN
D57850Medicare UPIN