MEDICARE: DR. JUSTIN CROSBY DO

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	83649	SC

General Provider Information

NPI Number	:	1699357087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN CROSBY DO

Provider Business Mailing Address
First Line	:	108 FINNEGAN CT
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4205
Country	:	US
Telephone Number	:	843-903-9993
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 FINNEGAN CT
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4205
Country	:	US
Telephone Number	:	843-903-9993
Fax Number	:

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

Provider Enumeration Date	:	04/25/2021
Last Update Date	:	08/27/2024

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