Most Relevant Information
Provider Data
| NPI Number: | 1003377151 |
| Provider Name: | JUSTIN YATES CROCKETT |
| Entity Type: | Individual |
| Taxonomy Code: | 174400000X |
| Specialty: | Specialist |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/29/2019 |
| Last Updated: | 07/16/2024 |
Provider Practice Location
51 FAIRVIEWSTREET
BRATTLEBORO
VT
053012579
Practice Location Phone/Fax
| Phone: | 8022546028 |
| Fax: | 8022547501 |
Provider Mailing Location
390 RIVER STREET
SPRINGFIELD
VT
051562226
Provider Mailing Phone/Fax
| Phone: | 8028864500 |
| Fax: | 8028864520 |