Provider Demographics
NPI:1780649897
Name:CROCKETT, BARBARA P (MD)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:P
Last Name:CROCKETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8160 WALNUT HILL LN
Mailing Address - Street 2:306
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231
Mailing Address - Country:US
Mailing Address - Phone:214-373-7800
Mailing Address - Fax:214-373-1102
Practice Address - Street 1:8160 WALNUT HILL LN
Practice Address - Street 2:306
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:214-373-7800
Practice Address - Fax:214-373-1102
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9337207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106281202Medicaid
TX89K912Medicare PIN
TX106281202Medicaid