MEDICARE: DAGMAR CROSBY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	13107555-1205	UT

General Provider Information

NPI Number	:	1154303352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAGMAR CROSBY MD

Provider Business Mailing Address
First Line	:	1036 E RIVERSIDE DR
Second Line	:
City	:	SAINT GEORGE
State	:	UT
Zip	:	84790-4477
Country	:	US
Telephone Number	:	435-656-0022
Fax Number	:

Provider Business Practice Location Address
First Line	:	1036 E RIVERSIDE DR
Second Line	:
City	:	SAINT GEORGE
State	:	UT
Zip	:	84790-4477
Country	:	US
Telephone Number	:	435-656-0022
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	06/20/2023

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