Provider Demographics
NPI:1689887770
Name:CROSBY, GAIL KRISTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:KRISTIN
Last Name:CROSBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:CROSBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1899
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NC
Mailing Address - Zip Code:28675-1899
Mailing Address - Country:US
Mailing Address - Phone:206-399-1015
Mailing Address - Fax:
Practice Address - Street 1:33431 13TH PL S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6357
Practice Address - Country:US
Practice Address - Phone:253-874-7634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22998207Q00000X
WV16042207Q00000X
WAMD00038160207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4274491Medicare PIN