Provider Demographics
NPI:1225368566
Name:CROSBY, WALLACE DODDS (MD)
Entity Type:Individual
Prefix:DR
First Name:WALLACE
Middle Name:DODDS
Last Name:CROSBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1378 VALLOMBROSA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2956
Mailing Address - Country:US
Mailing Address - Phone:530-343-0054
Mailing Address - Fax:
Practice Address - Street 1:1378 VALLOMBROSA AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2956
Practice Address - Country:US
Practice Address - Phone:530-343-0054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-20091207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine