| John A Crockett Md, A Professional Corporation | |
|
240 La Casa Via Ste 100 Walnut Creek CA 94598-4863 | |
| (925) 519-2866 | |
| (925) 692-5522 |
| Full Name | John A Crockett Md, A Professional Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 240 La Casa Via Ste 100, Walnut Creek, California |
| Authorized Official Name and Position | Karl F Stemmler (CREDENTIALER) |
| Authorized Official Contact | 6192586200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John A Crockett Md, A Professional Corporation 210 La Colina Dr Alamo CA 94507-1816 Ph: (925) 519-2866 | John A Crockett Md, A Professional Corporation 240 La Casa Via Ste 100 Walnut Creek CA 94598-4863 Ph: (925) 519-2866 |
| NPI Number | 1265758460 |
|---|---|
| Provider Enumeration Date | 04/13/2010 |
| Last Update Date | 12/22/2022 |
| Medicare PECOS PAC ID | 9234261637 |
|---|---|
| Medicare Enrollment ID | O20230207002907 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265758460 | NPI | - | NPPES |
| 1134221021 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G230620 (California) | Primary |
| 207V00000X | Obstetrics & Gynecology | G230620 (California) | Secondary |
| Provider Name | John A Crockett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134221021 PECOS PAC ID: 2668502584 Enrollment ID: I20100618000651 |
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