Provider Demographics
NPI:1346528437
Name:CROSSMAN, NICHOLAS W (DO)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:W
Last Name:CROSSMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-7605
Mailing Address - Country:US
Mailing Address - Phone:850-785-4344
Mailing Address - Fax:850-763-5456
Practice Address - Street 1:1827 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-7605
Practice Address - Country:US
Practice Address - Phone:850-785-4344
Practice Address - Fax:850-763-5456
Is Sole Proprietor?:No
Enumeration Date:2011-07-24
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT014819207X00000X
NVDO2165207X00000X
FLOS15465207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDO2165OtherNV MEDICAL LICENSE
FLOS15465OtherFL MEDICAL LICENSE