Healthcare Provider Details

I. General information

NPI: 1124131990
Provider Name (Legal Business Name): ARCHER CROSLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 LINDBERG AVE
MCALLEN TX
78501-2922
US

IV. Provider business mailing address

412 LINDBERG AVE
MCALLEN TX
78501-2922
US

V. Phone/Fax

Practice location:
  • Phone: 956-664-2880
  • Fax: 956-664-2802
Mailing address:
  • Phone: 956-664-2880
  • Fax: 956-664-2802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG4941
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: