Provider Demographics
NPI:1487067443
Name:CROCKER, EPHRAIM (NMD)
Entity type:Individual
Prefix:DR
First Name:EPHRAIM
Middle Name:
Last Name:CROCKER
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 SW 42ND ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-9617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:520 W UNION HILLS DR STE 104
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-5633
Practice Address - Country:US
Practice Address - Phone:800-928-8127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-08
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172P00000X
HIND-292175F00000X
AZ14-1436175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No172P00000XOther Service ProvidersNaprapath