Provider Demographics
NPI:1932141892
Name:CROMMETT, JOHN WILSON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILSON
Last Name:CROMMETT
Suffix:
Gender:M
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:PO BOX 4439
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4439
Mailing Address - Country:US
Mailing Address - Phone:713-792-2991
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4009
Practice Address - Country:US
Practice Address - Phone:713-792-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0781207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157524305 (MDACC)Medicaid
TXP00691104OtherRR MEDICARE (MDACC)
TX8U5755OtherBCBS (MDACC)
TX8H8051OtherBC/BS
TX8H8051OtherBC/BS
TXP00691104OtherRR MEDICARE (MDACC)
TX8L4987 (MDACC)Medicare PIN
TXP00008928Medicare PIN