Healthcare Provider Details

I. General information

NPI: 1326591058
Provider Name (Legal Business Name): GALE DAHLAGER CROZIER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 INTERLOOP RD JACKSON LAKE LODGE
MORAN WY
83013
US

IV. Provider business mailing address

PO BOX 15240
JACKSON WY
83002-5240
US

V. Phone/Fax

Practice location:
  • Phone: 307-543-2514
  • Fax:
Mailing address:
  • Phone: 307-543-2514
  • Fax: 307-733-0032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPT 675
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: