Provider Demographics
NPI:1639753080
Name:CROCKER, ALSCE GREGORY
Entity Type:Individual
Prefix:MR
First Name:ALSCE
Middle Name:GREGORY
Last Name:CROCKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 FANNIN SPEEDWAY APT 3102
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77045-5059
Mailing Address - Country:US
Mailing Address - Phone:619-750-7795
Mailing Address - Fax:
Practice Address - Street 1:1818 FANNIN SPEEDWAY APT 3102
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-5059
Practice Address - Country:US
Practice Address - Phone:619-750-7795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator