Provider Demographics
NPI:1760561880
Name:CRNKOVIC, JOE D (ACA)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:D
Last Name:CRNKOVIC
Suffix:
Gender:M
Credentials:ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 S TEXAS AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3769
Mailing Address - Country:US
Mailing Address - Phone:979-779-3070
Mailing Address - Fax:979-779-7565
Practice Address - Street 1:3600 S TEXAS AVE STE 400
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3769
Practice Address - Country:US
Practice Address - Phone:979-779-3070
Practice Address - Fax:979-779-7565
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50236237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX022122801Medicaid
TX516533OtherBLUE CROSS BLUE SHIELD