Healthcare Provider Details

I. General information

NPI: 1063793586
Provider Name (Legal Business Name): MICHAEL K CROSSLEY, M D P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 N MAIN ST
VIDOR TX
77662-3018
US

IV. Provider business mailing address

1880 N MAIN ST
VIDOR TX
77662-3018
US

V. Phone/Fax

Practice location:
  • Phone: 409-783-2277
  • Fax: 409-783-2701
Mailing address:
  • Phone: 409-783-2277
  • Fax: 409-783-2701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH9871
License Number StateTX

VIII. Authorized Official

Name: CHRISTOPHER ELEFANO QUIRANTE
Title or Position: PHYSICIAN ASSISTANT/ADMINISTRATOR
Credential: PA-C
Phone: 409-783-2277