Provider Demographics
NPI:1376532739
Name:CROSSWRIGHT, EARL JAY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:JAY
Last Name:CROSSWRIGHT
Suffix:JR
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 1:841 W MALLORY ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-6321
Mailing Address - Country:US
Mailing Address - Phone:850-332-6704
Mailing Address - Fax:888-793-0432
Practice Address - Street 1:841 W MALLORY ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6321
Practice Address - Country:US
Practice Address - Phone:850-332-6704
Practice Address - Fax:888-793-0432
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116621900Medicaid
FL18356OtherBLUE CROSS BLUE SHIELD
FLP00405780OtherMEDICARE RAILROAD
F46081Medicare UPIN
FL18356ZMedicare PIN