Crockett, Evan A.
Crockett, Evan A. is an individual health care provider with primary practice located at 30 N Mario Capecchi Dr Rm 4S100 , Salt Lake City UT 84112. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Urology. Allopathic & Osteopathic Physicians / Urology is his primary health care specialty. Crockett, Evan A. can be contacted via phone (801) 581-2121.Contact Information
Primary practice address
30 N Mario Capecchi Dr Rm 4S100
Salt Lake City UT 84112
Phone: (801) 581-2121
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | BP10080668 | Texas |
| Allopathic & Osteopathic Physicians / Urology | 208800000X | 13548246-1205 | Utah |
Profile Details
| NPI number | 1093448607 |
|---|---|
| LBN Legal business name | Crockett, Evan A. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 1st, 2022 |
| Last updated | Aug 22nd, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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