MEDICARE: DR. PATRICK G MCCROSSEN DDS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	19928	LA
2	207R00000X	Internal Medicine Physician	15060	MS
3	122300000X	Dentist	3309	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073539300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK G MCCROSSEN DDS MD

Provider Business Mailing Address
First Line	:	PO BOX 7828
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70010-7828
Country	:	US
Telephone Number	:	504-451-6423
Fax Number	:

Provider Business Practice Location Address
First Line	:	4502 LOUISIANA HWY 951
Second Line	:
City	:	JACKSON
State	:	LA
Zip	:	70748
Country	:	US
Telephone Number	:	225-634-0413
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	05/03/2018

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