Healthcare Provider Details

I. General information

NPI: 1891783072
Provider Name (Legal Business Name): JOHN CLIFTON CROSBY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4580 BLUEBONNET BLVD
BATON ROUGE LA
70809-5604
US

IV. Provider business mailing address

PO BOX 9600 DEPT 09-039 MEDICAL CENTER ANESTHESIOLOGISTS
TEXARKANA TX
75505-9600
US

V. Phone/Fax

Practice location:
  • Phone: 504-754-2334
  • Fax:
Mailing address:
  • Phone: 318-868-3151
  • Fax: 318-861-3156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number021149
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number021149
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: