Provider Demographics
NPI:1558357947
Name:CROCKER, LYNN ANN (DO)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ANN
Last Name:CROCKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:ANN
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 29834
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9834
Mailing Address - Country:US
Mailing Address - Phone:602-553-8400
Mailing Address - Fax:602-553-8408
Practice Address - Street 1:1111 E MCDOWELL RD
Practice Address - Street 2:WT LL1 CASE MANAGEMENT
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2612
Practice Address - Country:US
Practice Address - Phone:602-839-2000
Practice Address - Fax:602-839-5918
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3966207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ862781-01Medicaid
AZZ129872Medicare PIN
AZZ80658Medicare PIN
AZI05899Medicare UPIN
AZ862781-01Medicaid