Healthcare Provider Details

I. General information

NPI: 1831161900
Provider Name (Legal Business Name): JEFFREY CRAIG CROSBY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 09/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 S PONDEROSA ST
PAYSON AZ
85541-5542
US

IV. Provider business mailing address

807 S. PONDEROSA
PAYSON AZ
85541-5542
US

V. Phone/Fax

Practice location:
  • Phone: 928-472-1380
  • Fax:
Mailing address:
  • Phone: 928-472-1380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number28316
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: