Healthcare Provider Details

I. General information

NPI: 1164288759
Provider Name (Legal Business Name): JOSEPH CROSBY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 01/03/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 DEER RIDGE DR
FLORA MS
39071-9563
US

IV. Provider business mailing address

125 DEER RIDGE DR
FLORA MS
39071-9563
US

V. Phone/Fax

Practice location:
  • Phone: 315-576-6916
  • Fax:
Mailing address:
  • Phone: 315-576-6916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: