Provider Demographics
NPI:1326591058
Name:CROZIER, GALE DAHLAGER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:GALE
Middle Name:DAHLAGER
Last Name:CROZIER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15240
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-5240
Mailing Address - Country:US
Mailing Address - Phone:307-543-2514
Mailing Address - Fax:307-733-0032
Practice Address - Street 1:1 INTERLOOP RD
Practice Address - Street 2:JACKSON LAKE LODGE
Practice Address - City:MORAN
Practice Address - State:WY
Practice Address - Zip Code:83013
Practice Address - Country:US
Practice Address - Phone:307-543-2514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT 675363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant